Provider Demographics
NPI:1306070164
Name:MID-COUNTY PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:MID-COUNTY PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:SHERMAN
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:III
Authorized Official - Credentials:PT
Authorized Official - Phone:703-763-3922
Mailing Address - Street 1:12581 MILSTEAD WAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192
Mailing Address - Country:US
Mailing Address - Phone:703-763-3922
Mailing Address - Fax:
Practice Address - Street 1:12581 MILSTEAD WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192
Practice Address - Country:US
Practice Address - Phone:703-763-3922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-08
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305006481261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy