Provider Demographics
NPI:1588495469
Name:MODI-SKEATH, ORLI ELIZABETH (DPT)
Entity type:Individual
Prefix:
First Name:ORLI
Middle Name:ELIZABETH
Last Name:MODI-SKEATH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25454 BRICKELL DR
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20152-2041
Mailing Address - Country:US
Mailing Address - Phone:240-355-1856
Mailing Address - Fax:
Practice Address - Street 1:24801 PINEBROOK RD STE 120
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20152-4113
Practice Address - Country:US
Practice Address - Phone:703-722-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305216706225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist