Individual provider Active NPI

Tupper D Gillie Sr., DPT

  • Physical Therapist
  • Woodbridge, VA
National Provider Identifier
1578757464
Registry record updated May 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2305005275 Issued in VA
Practice address
14605 Potomac Branch Dr Ste 300
Woodbridge, VA 22191-3337
Phone
(703) 490-1112
Fax
(703) 878-8735
NPI assigned
Sep 4, 2007
Last updated
May 21, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2305005275 VA Primary
Orthopedic Physical Therapist 2251X0800X 7657 AZ

Addresses

Primary practice location

14605 Potomac Branch Dr Ste 300
Woodbridge, VA 22191-3337

Mailing address

14605 Potomac Branch Dr Ste 300
Woodbridge, VA 22191-3337
Phone (703) 490-1112

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250619000003 VA Practitioner - Physical Therapist in Private Practice 2062506330 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

14605 Potomac Branch Dr
Suite 300
Woodbridge, VA 22191-3337
Phone (703) 490-1112

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2305005275VAMDPhysical Therapist
7657AZMDOrthopedic Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Centers for Advanced Orthopaedics, LLC CurrentSince Jun 2, 2025 Accepting new patients
Centers for Advanced Orthopaedics, LLC CurrentSince Jun 2, 2025 Accepting new patients
Centers for Advanced Orthopaedics LLC Current Accepting new patients
Tucson Orthopaedic Institute Professional Corporation Physical Therapist Past Accepting new patients
In Touch Therapy, PLC Physical Therapist PastSince Sep 2, 2002 Accepting new patients

Locations

14605 Potomac Branch Dr
Ste 300
Woodbridge, VA 22191
Phone (703) 490-1112

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1188864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747785600000",
    "number": "1578757464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14605 POTOMAC BRANCH DR STE 300",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221913337",
            "telephone_number": "703-490-1112",
            "fax_number": "703-878-8735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14605 POTOMAC BRANCH DR STE 300",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221913337",
            "telephone_number": "703-490-1112",
            "fax_number": "703-878-8735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLIE",
        "first_name": "TUPPER",
        "middle_name": "D",
        "name_suffix": "Sr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-04",
        "last_updated": "2025-05-21",
        "certification_date": "2025-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305005275",
            "primary": true
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "AZ",
            "license": "7657",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbridge, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.