Provider Demographics
NPI:1942634464
Name:PEDIATRIC THERAPY PARTNERS OF NOVA, LLC
Entity type:Organization
Organization Name:PEDIATRIC THERAPY PARTNERS OF NOVA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MS, PT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISSY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-212-6145
Mailing Address - Street 1:3623 TUPELO PL
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-1844
Mailing Address - Country:US
Mailing Address - Phone:571-212-6145
Mailing Address - Fax:888-750-4126
Practice Address - Street 1:3623 TUPELO PL
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1844
Practice Address - Country:US
Practice Address - Phone:571-212-6145
Practice Address - Fax:888-750-4126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204619225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty