Evergreen Clinic, PLLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2305209030 Issued in VA

Legal business name

EVERGREEN CLINIC, PLLC

Practice address

14540 John Marshall Hwy Ste 202
Gainesville, VA 20155-1693

Phone

(703) 753-9700

Fax

(703) 753-9701

NPI assigned

Jul 13, 2017

Organization subpart

No

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

Authorized official

Name

Mrs. Jacqueline Stiles, DPT

Title

Physical Therapist

Phone

(443) 622-9641

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1499904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1499904000000",
    "number": "1265954960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15670 HUNTON LN",
            "city": "HAYMARKET",
            "state": "VA",
            "postal_code": "201691733",
            "telephone_number": "443-622-9641",
            "fax_number": "703-753-9701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14540 JOHN MARSHALL HWY STE 202",
            "city": "GAINESVILLE",
            "state": "VA",
            "postal_code": "201551693",
            "telephone_number": "703-753-9700",
            "fax_number": "703-753-9701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-13",
        "last_updated": "2017-07-13",
        "status": "A",
        "authorized_official_last_name": "STILES",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "443-622-9641",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305209030",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2017; 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.