1871959726 NPI number — PRIMUS PHYSICAL THERAPY

Table of content: DR. STEPHEN NEAL SCHILT M.D. (NPI 1679659965)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871959726 NPI number — PRIMUS PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIMUS PHYSICAL THERAPY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871959726
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6101 REDWOOD SQUARE CTR
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
CENTREVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20121-4265
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-642-5096
Provider Business Mailing Address Fax Number:
703-995-0284

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6101 REDWOOD SQUARE CTR
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
CENTREVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-543-6660
Provider Business Practice Location Address Fax Number:
703-995-0284
Provider Enumeration Date:
01/07/2016

Additional Information

Authorized Official

Authorized Official Last Name:
DE CONTI
Authorized Official First Name:
JACQUELINE
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINICAL SERVICES DIRECTOR
Authorized Official Telephone Number:
443-812-9890

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  230525109 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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