NPIMap

Organization Active NPI

Coach House Physicial Therapy&Sports Medicine Center, LLC

  • Physical Therapist
  • Dumfries, VA
National Provider Identifier
1801971601
Registry record updated Aug 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2305103005 Issued in VA
Legal business name
COACH HOUSE PHYSICIAL THERAPY&SPORTS MEDICINE CENTER, LLC
Practice address
17453 Richmond Hwy
Dumfries, VA 22026-2244
Phone
(703) 221-3913
Fax
(703) 221-3203
NPI assigned
Oct 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2022

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

Authorized official

Name
Edward Brock Price, MPT
Title
Physical Therapist, Owner
Phone
(703) 221-3913

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 2305103005 VA Primary

Addresses

Primary practice location

17453 Richmond Hwy
Dumfries, VA 22026-2244

Mailing address

17453 Richmond Hwy
Dumfries, VA 22026-2244
Phone (703) 221-3913

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050913000137 VA Part B Supplier - Clinic/Group Practice 2860425717 Receives reassigned benefits from 4 practitioners
Practice locations: Dumfries, VA

National Provider Directory

National Provider Directory

Locations

17453 Fraley Blvd
Dumfries, VA 22026
Phone (703) 220-3913

17451 Fraley Blvd
Dumfries, VA 22026
Phone (703) 221-3913

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659484800000",
    "number": "1801971601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17453 RICHMOND HWY",
            "city": "DUMFRIES",
            "state": "VA",
            "postal_code": "220262244",
            "telephone_number": "703-221-3913",
            "fax_number": "703-221-3203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17453 RICHMOND HWY",
            "city": "DUMFRIES",
            "state": "VA",
            "postal_code": "220262244",
            "telephone_number": "703-221-3913",
            "fax_number": "703-221-3203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COACH HOUSE PHYSICIAL THERAPY&SPORTS MEDICINE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2022-08-03",
        "certification_date": "2022-07-25",
        "status": "A",
        "authorized_official_last_name": "PRICE",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "BROCK",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST, OWNER",
        "authorized_official_telephone_number": "703-221-3913",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305103005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dumfries, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.