Provider Demographics
NPI:1316320153
Name:MOUNT VERNON PHYSICAL THERAPY LC
Entity type:Organization
Organization Name:MOUNT VERNON PHYSICAL THERAPY LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SARRO
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:571-481-4547
Mailing Address - Street 1:7910 ANDRUS RD STE 5
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3171
Mailing Address - Country:US
Mailing Address - Phone:571-481-4547
Mailing Address - Fax:571-551-6419
Practice Address - Street 1:7910 ANDRUS RD STE 5
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3171
Practice Address - Country:US
Practice Address - Phone:571-481-4547
Practice Address - Fax:571-551-6419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-29
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205940225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========OtherEIN