Basic Information
Provider Information | |||||||||
NPI: | 1427325216 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MORRIS | ||||||||
FirstName: | CHARLESETTA | ||||||||
MiddleName: | BENNITA | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PT, DPT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1769 | ||||||||
Address2: |   | ||||||||
City: | MIDDLEBURG | ||||||||
State: | VA | ||||||||
PostalCode: | 201181769 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7037297920 | ||||||||
FaxNumber: | 7037297923 | ||||||||
Practice Location | |||||||||
Address1: | 43490 YUKON DR STE 212 | ||||||||
Address2: |   | ||||||||
City: | ASHBURN | ||||||||
State: | VA | ||||||||
PostalCode: | 201477326 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7037297920 | ||||||||
FaxNumber: | 7037297923 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/21/2011 | ||||||||
LastUpdateDate: | 09/22/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/22/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305207187 | VA | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
No ID Information.