Collin Bradley
Individual provider Active NPI Physical Therapist · Aldie, VA
NPI 1891454088 · NPPES record last updated Dec 15, 2021
Key facts
- NPI
- 1891454088
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PENDING (VA)
- Practice address
- 24560 Southpoint Dr
Aldie, VA 20105-3510 - Phone
- (571) 370-3686
- NPI assigned
- Dec 15, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Jackson Clinics Limited Partnership
Practice addresses (Care Compare)
43490 Yukon Dr
Ashburn, VA 20147-6990
Phone (703) 729-7920
5900 Fort Dr
Suite 208
Centreville, VA 20121-2425
Phone (703) 830-6360
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in DC, VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240516001574 | DC | Practitioner - Physical Therapist in Private Practice | 6002257490 | Reassigns benefits to 1 organization |
| I20240530002734 | VA | Practitioner - Physical Therapist in Private Practice | 6002257490 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PENDING | VA | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jackson Clinics Limited Partnership | Physical Therapist | Current |
Accepting new patients |
Locations
24560 Southpoint Dr
Aldie, VA 20105
Phone (571) 370-3686
43490 Yukon Dr
Ashburn, VA 20147
Phone (703) 729-7920
5900 Fort Dr
Ste 208
Centreville, VA 20121
Phone (703) 830-6360
12701 Fair Lakes Cir
Ste 102
Fairfax, VA 22033
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PENDING | VA | Yes |
Addresses
Primary practice location
24560 Southpoint Dr
Aldie, VA 20105-3510
Mailing address
PO Box 1769
Middleburg, VA 20118-1769
Phone (703) 729-7920
Other providers in Aldie, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 15, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.