Provider Demographics
NPI:1538595160
Name:MARSHALL PHYSICAL THERAPY
Entity type:Organization
Organization Name:MARSHALL PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHARINE
Authorized Official - Middle Name:
Authorized Official - Last Name:AYRES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:703-737-3697
Mailing Address - Street 1:8272 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:VA
Mailing Address - Zip Code:20115-3227
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8272 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:VA
Practice Address - Zip Code:20115-3227
Practice Address - Country:US
Practice Address - Phone:703-737-3697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-14
Last Update Date:2013-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305831290261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy