1821033564 NPI number — ACE PHYSICAL THERAPY & SPORTS MEDICINE INSTITUTE, 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 1821033564 NPI number — ACE PHYSICAL THERAPY & SPORTS MEDICINE INSTITUTE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACE PHYSICAL THERAPY & SPORTS MEDICINE INSTITUTE, 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:
1821033564
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2841 HARTLAND RD
Provider Second Line Business Mailing Address:
SUITE 401B
Provider Business Mailing Address City Name:
FALLS CHURCH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-205-1233
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 ELDEN ST.
Provider Second Line Business Practice Location Address:
SUITE 12
Provider Business Practice Location Address City Name:
HERNDON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20170-4876
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-205-1233
Provider Business Practice Location Address Fax Number:
703-641-0189
Provider Enumeration Date:
06/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ERCOLE
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DIRECTOR/OWNER
Authorized Official Telephone Number:
703-205-1233

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2305004004 , 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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