Provider Demographics
NPI:1841717774
Name:MOBILE ORTHOPAEDICS & REHABILITATION, PT
Entity type:Organization
Organization Name:MOBILE ORTHOPAEDICS & REHABILITATION, PT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MASIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:703-361-9677
Mailing Address - Street 1:9010 HORNBAKER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-3963
Mailing Address - Country:US
Mailing Address - Phone:703-361-9677
Mailing Address - Fax:703-361-9678
Practice Address - Street 1:9010 HORNBAKER RD STE 101
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-3963
Practice Address - Country:US
Practice Address - Phone:703-361-9677
Practice Address - Fax:703-361-9678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA16L164022251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty