Provider Demographics
NPI:1447645551
Name:NATIONAL SPORTS MEDICINE INSTITUTE
Entity type:Organization
Organization Name:NATIONAL SPORTS MEDICINE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-729-5010
Mailing Address - Street 1:19455 DEERFIELD AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8100
Mailing Address - Country:US
Mailing Address - Phone:703-729-5010
Mailing Address - Fax:703-729-5833
Practice Address - Street 1:19455 DEERFIELD AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-8100
Practice Address - Country:US
Practice Address - Phone:703-729-5010
Practice Address - Fax:703-729-5833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306602067261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy