Basic Information
| Provider Information | |||||||||
| NPI: | 1639292295 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRO MOTION PHYSICAL THERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6849 OLD DOMINION DR | ||||||||
| Address2: | SUITE 221 | ||||||||
| City: | MCLEAN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221013724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038489333 | ||||||||
| FaxNumber: | 7038480660 | ||||||||
| Practice Location | |||||||||
| Address1: | 6849 OLD DOMINION DR | ||||||||
| Address2: | SUITE 221 | ||||||||
| City: | MCLEAN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221013724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038489333 | ||||||||
| FaxNumber: | 7038480660 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CHARAIPOTRA | ||||||||
| AuthorizedOfficialFirstName: | PUJA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CO-OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7038489333 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | P.T. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | VA | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
ID Information
| ID | Type | State | Issuer | Description | J757 | 01 | VA | BCBS | OTHER |