Provider Demographics
NPI:1215149125
Name:ACTIVE BODY PHYSICAL THERAPY WELLNESS, PLLC
Entity type:Organization
Organization Name:ACTIVE BODY PHYSICAL THERAPY WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:703-913-5705
Mailing Address - Street 1:8346 TRAFORD LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1600
Mailing Address - Country:US
Mailing Address - Phone:703-913-5705
Mailing Address - Fax:703-913-5706
Practice Address - Street 1:8346 TRAFORD LN
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1600
Practice Address - Country:US
Practice Address - Phone:703-913-5705
Practice Address - Fax:703-913-5706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202877225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty