Basic Information
| Provider Information | |||||||||
| NPI: | 1376812149 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VALENS PHYSICAL THERAPY & SPORTS PERFORMANCE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1501 DUKE ST | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223143468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035355491 | ||||||||
| FaxNumber: | 7035355494 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 DUKE ST | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223143468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035355491 | ||||||||
| FaxNumber: | 7035355494 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2011 | ||||||||
| LastUpdateDate: | 04/02/2012 | ||||||||
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| AuthorizedOfficialLastName: | MAZIN | ||||||||
| AuthorizedOfficialFirstName: | MAKENZIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 7035355491 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DSCPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 2305203359 | VA | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.