Provider Demographics
NPI:1619006947
Name:ITR PHYSICAL THERAPY. INC
Entity type:Organization
Organization Name:ITR PHYSICAL THERAPY. INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:301-770-7060
Mailing Address - Street 1:2211 WAKEROBIN LN
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-4105
Mailing Address - Country:US
Mailing Address - Phone:703-855-0281
Mailing Address - Fax:703-991-5369
Practice Address - Street 1:1313 DOLLEY MADISON BLVD STE 405
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3953
Practice Address - Country:US
Practice Address - Phone:301-770-7060
Practice Address - Fax:703-991-5369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-04
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18949174400000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty