1275604415 NPI number — MCLEAN PHYSICAL THERAPY & REHAB SERVICES, LLC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275604415 NPI number — MCLEAN PHYSICAL THERAPY & REHAB SERVICES, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCLEAN PHYSICAL THERAPY & REHAB SERVICES, LLC.
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:
1275604415
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1515 CHAIN BRIDGE RD
Provider Second Line Business Mailing Address:
SUITE #104
Provider Business Mailing Address City Name:
MCLEAN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22101-4451
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-356-7801
Provider Business Mailing Address Fax Number:
703-356-7814

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1515 CHAIN BRIDGE RD
Provider Second Line Business Practice Location Address:
SUITE #104
Provider Business Practice Location Address City Name:
MCLEAN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22101-4451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-356-7801
Provider Business Practice Location Address Fax Number:
703-356-7814
Provider Enumeration Date:
11/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DECKX
Authorized Official First Name:
ANNE-MARIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
703-356-7801

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  4550 , 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)

  • Identifier: J684 . This is a "BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 3318097 . This is a "AETNA HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7400481 . This is a "AETNA PPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".