Basic Information
Provider Information | |||||||||
NPI: | 1528122835 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MCDONALD | ||||||||
FirstName: | ERIN | ||||||||
MiddleName: | BURLOVICH | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PT, DPT, OCS | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BURLOVICH | ||||||||
OtherFirstName: | ERIN | ||||||||
OtherMiddleName: | MARIE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PT, DPT, OCS | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1769 | ||||||||
Address2: |   | ||||||||
City: | MIDDLEBURG | ||||||||
State: | VA | ||||||||
PostalCode: | 20118 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5406878181 | ||||||||
FaxNumber: | 5406878256 | ||||||||
Practice Location | |||||||||
Address1: | 13890 BRADDOCK RD | ||||||||
Address2: | SUITE 102 | ||||||||
City: | CENTREVILLE | ||||||||
State: | VA | ||||||||
PostalCode: | 201212435 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7038306360 | ||||||||
FaxNumber: | 7038306362 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/21/2006 | ||||||||
LastUpdateDate: | 07/22/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 21489 | MD | N |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   | 225100000X | 2305204299 | VA | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
No ID Information.