Mary Debolt, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2305216481 Issued in VA

Practice address

6408 Grovedale Drive, Suite 102
Alexandria, VA 22310-2596

Phone

(703) 884-8490

NPI assigned

May 29, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Virginia Commonwealth University, School of Medicine, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Loudoun Medical Group, PCGroup PAC ID 0042119661, 272 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mary.debolt@lmg1.eclinicaldirectplus.com

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

• Loudoun Medical Group, PC

  • Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician
  • Reston, VA
  • NPI 1407908817

  DC

  Medicare reassignment Care Compare group NPD
• Loudoun Medical Group, PC

  • Vascular Surgery Physician
  • Reston, VA
  • NPI 1588376321
  NPD
• Loudoun Medical Group, PC

  • Vascular & Interventional Radiology Physician
  • Reston, VA
  • NPI 1669147583
  NPD
• Loudoun Medical Group, PC

  • Internal Medicine Physician
  • Leesburg, VA
  • NPI 1679591440
  NPD

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

{
    "created_epoch": "1716940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726444800000",
    "number": "1649010331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224-D CORNWALL STREET, NW, SUITE 403",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201762704",
            "telephone_number": "703-737-6010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6408 GROVEDALE DRIVE, SUITE 102",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223102596",
            "telephone_number": "703-884-8490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEBOLT",
        "first_name": "MARY",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-05-29",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305216481",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30017889730001",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erica Deam, NP-C
• Dean J Storer MD PC
• Lauren Elizabeth Deangelis, CRNA
• Daniel J Deary, CRNA
• Gina Deblasio, PA-C
• Russell Anthony Decarlo, DDS
• Willaim Allen Decker, PH. D.
• Monique Jeanne Deely, LCSW
• Imani Deen, LPC
• Saffie Deen, LPN

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2024; 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.