Active for Life Physical Therapy

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

ACTIVE FOR LIFE PHYSICAL THERAPY

Practice address

511 Fillmore St
Herndon, VA 20170-3314

Phone

(703) 249-9757

Fax

(703) 520-5485

NPI assigned

Dec 15, 2019

Last updated

Dec 15, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Maude Bertovich, PT, DPT

Title

Physical Therapist

Phone

(703) 597-4358

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1576368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576368000000",
    "number": "1407494990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 FILLMORE ST",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "201703314",
            "telephone_number": "703-597-4358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 FILLMORE ST",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "201703314",
            "telephone_number": "703-249-9757",
            "fax_number": "703-520-5485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE FOR LIFE PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-15",
        "last_updated": "2019-12-15",
        "certification_date": "2019-12-15",
        "status": "A",
        "authorized_official_last_name": "BERTOVICH",
        "authorized_official_first_name": "MAUDE",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "703-597-4358",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Herndon, VA
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• Physical Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2019; 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.