Basic Information
| Provider Information | |||||||||
| NPI: | 1912454737 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOYLE | ||||||||
| FirstName: | ROBERT | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 46161 WESTLAKE DR | ||||||||
| Address2: | STE 330 | ||||||||
| City: | STERLING | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201655871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7036893737 | ||||||||
| FaxNumber: | 7036893889 | ||||||||
| Practice Location | |||||||||
| Address1: | 46161 WESTLAKE DR | ||||||||
| Address2: | STE 330 | ||||||||
| City: | STERLING | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201655871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7036893737 | ||||||||
| FaxNumber: | 7036893889 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2016 | ||||||||
| LastUpdateDate: | 12/16/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305210658 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.