Tracy E Boles, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2305204913 Issued in VA

Practice address

11800 Sunrise Valley Dr Ste 100
Reston, VA 20191-5309

Phone

(703) 709-1116

Fax

(703) 709-5134

NPI assigned

Mar 17, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1300320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638403200000",
    "number": "1225337223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11800 SUNRISE VALLEY DR STE 100",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201915309",
            "telephone_number": "703-709-1116",
            "fax_number": "703-709-5134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11800 SUNRISE VALLEY DR STE 100",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201915309",
            "telephone_number": "703-709-1116",
            "fax_number": "703-709-5134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLES",
        "first_name": "TRACY",
        "middle_name": "E",
        "name_prefix": "Mrs.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-17",
        "last_updated": "2021-12-02",
        "certification_date": "2021-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305204913",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blue Dolphin Home Health Care Services LLC.
• Blue Dolphin Home Health Care Services LLC.
• Lois Blush
• Bodies in Motion Physical Therapy II, LLC
• Body by Geoff
• Katherine Julia Bolin, MA
• Cameron Bolinder
• Mary Bolton-Owens, L.P.C.
• Liliana Elizabeth Bonilla Hernandez, FNP-BC
• Mary Bonvissuto, APRN

• Physical Therapist in Reston, VA
• Providers in Reston, VA by specialty
• Physical Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.