1699864876 NPI number — PHYSICAL THERAPY CONNECTION OF MCLEAN LP

Table of content: (NPI 1699864876)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699864876 NPI number — PHYSICAL THERAPY CONNECTION OF MCLEAN LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICAL THERAPY CONNECTION OF MCLEAN LP
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:
6
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:
1699864876
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 W SAM HOUSTON PKWY S
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77042-2447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-297-7000
Provider Business Mailing Address Fax Number:
713-297-7090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
209 ELDEN ST
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
HERNDON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20170-4852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-481-3551
Provider Business Practice Location Address Fax Number:
703-481-3276
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KING
Authorized Official First Name:
JANNA
Authorized Official Middle Name:
Authorized Official Title or Position:
VP,AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
713-297-7000

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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