Pavilion Outpatient Therapy LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

PAVILION OUTPATIENT THERAPY LLC

Practice address

4115 Annandale Rd Ste 202
Annandale, VA 22003-2500

Phone

(703) 299-9898

Fax

(703) 299-9595

NPI assigned

Sep 16, 2019

Organization subpart

Yes

Parent organization

PAVILION MEDICAL HOME CARE & STAFFING, LLCAs reported in NPPES

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

Authorized official

Name

Gibson Erhunmwunse, CRNP

Title

Ceo

Phone

(703) 299-9898

Specialties & licenses 2

Addresses

Part of

Pavilion Medical Home Care Staffing LLC

Locations

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

{
    "created_epoch": "1568592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568592000000",
    "number": "1689224248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4115 ANNANDALE RD STE 202",
            "city": "ANNANDALE",
            "state": "VA",
            "postal_code": "220032500",
            "telephone_number": "703-299-9898",
            "fax_number": "703-299-9595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4115 ANNANDALE RD STE 202",
            "city": "ANNANDALE",
            "state": "VA",
            "postal_code": "220032500",
            "telephone_number": "703-299-9898",
            "fax_number": "703-299-9595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAVILION OUTPATIENT THERAPY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PAVILION MEDICAL HOME CARE & STAFFING, LLC",
        "enumeration_date": "2019-09-16",
        "last_updated": "2019-09-16",
        "status": "A",
        "authorized_official_last_name": "ERHUNMWUNSE",
        "authorized_official_first_name": "GIBSON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "703-299-9898",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul Acupuncture and Wellness
• Christina Louise Paul, M.D.
• Pavilion Legacy Hospice & Palliative Care, LLC
• Pavilion Med Transportation, LLC
• Pavilion Medical Home Care & Staffing, LLC
• Pavilion Pace, LLC
• Pediatric Surgical Associates of Northern Virginia
• Loverly Glaze Pelayo-Pugh
• Leonel Perez Jr., D.D.S, M.D., F.A.C.S
• Personic Neuropsych PLLC

• Physical Therapist in Annandale, VA
• Providers in Annandale, 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, 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.