Provider Demographics
NPI:1235316696
Name:NEUROLOGICAL PHYSICAL THERAPY, PLLC
Entity type:Organization
Organization Name:NEUROLOGICAL PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:M
Authorized Official - Last Name:LICHY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:703-533-1515
Mailing Address - Street 1:7115 LEESBURG PIKE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-2367
Mailing Address - Country:US
Mailing Address - Phone:703-533-1515
Mailing Address - Fax:703-894-4916
Practice Address - Street 1:7115 LEESBURG PIKE
Practice Address - Street 2:SUITE 305
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-2367
Practice Address - Country:US
Practice Address - Phone:703-533-1515
Practice Address - Fax:703-894-4916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG02293Medicare PIN