Provider Demographics
NPI:1407605702
Name:ACE PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:ACE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ERCOLE
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:703-205-1233
Mailing Address - Street 1:108 ELDEN ST STE 12
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4886
Mailing Address - Country:US
Mailing Address - Phone:703-464-0425
Mailing Address - Fax:703-464-0426
Practice Address - Street 1:108 ELDEN ST STE 12
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4886
Practice Address - Country:US
Practice Address - Phone:703-464-0425
Practice Address - Fax:703-464-0426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy