1588624118 NPI number — MRS. DEVIN L WURMAN DPT

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 1588624118 NPI number — MRS. DEVIN L WURMAN DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WURMAN
Provider First Name:
DEVIN
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOLDSTEIN
Provider Other First Name:
DEVIN
Provider Other Middle Name:
LINDSAY
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588624118
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21251 RIDGETOP CIRCLE
Provider Second Line Business Mailing Address:
SUITE #140
Provider Business Mailing Address City Name:
STERLING
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20166
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-450-4300
Provider Business Mailing Address Fax Number:
703-450-5113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21251 RIDGETOP CIRCLE
Provider Second Line Business Practice Location Address:
SUITE #140
Provider Business Practice Location Address City Name:
STERLING
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-450-4300
Provider Business Practice Location Address Fax Number:
703-450-5113
Provider Enumeration Date:
03/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 2305206452 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: 2305206452 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2316204000 . This is a "BC BS PC KS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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