Provider Demographics
NPI:1124751219
Name:STATERA SPRING VALLEY LLC
Entity type:Organization
Organization Name:STATERA SPRING VALLEY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEPPERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-409-3483
Mailing Address - Street 1:603 W BROAD ST # 200
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3259
Mailing Address - Country:US
Mailing Address - Phone:713-409-3483
Mailing Address - Fax:
Practice Address - Street 1:4301 50TH ST NW STE 100
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4364
Practice Address - Country:US
Practice Address - Phone:202-448-9662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-06
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy