Provider Demographics
NPI:1700503067
Name:DELUXE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:DELUXE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PETYA
Authorized Official - Middle Name:
Authorized Official - Last Name:DJOUBRAILOV
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:703-679-8078
Mailing Address - Street 1:PO BOX 173
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-0173
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:243 CHURCH ST NW STE 100A
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4450
Practice Address - Country:US
Practice Address - Phone:703-679-8078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-26
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty