Basic Information
| Provider Information | |||||||||
| NPI: | 1093199275 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HAYMARKET PHYSICAL THERAPY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14535 JOHN MARSHALL HWY | ||||||||
| Address2: | 203 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201554023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037530261 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14535 JOHN MARSHALL HWY | ||||||||
| Address2: | 203 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201554023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037530974 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2015 | ||||||||
| LastUpdateDate: | 06/03/2020 | ||||||||
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| AuthorizedOfficialLastName: | WOELKERS | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | LEO | ||||||||
| AuthorizedOfficialTitleorPosition: | CO-OWNER/LICENSED PT | ||||||||
| AuthorizedOfficialTelephone: | 5708775433 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PT, DPT, CSCS | ||||||||
| NPICertificationDate: | 06/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305207830 | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.