Proactive Physical Therapy and Wellness LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

2305204873 Issued in VA

Legal business name

PROACTIVE PHYSICAL THERAPY AND WELLNESS LLC

Practice address

3903 Fair Ridge Dr
211
Fairfax, VA 22033-2943

Phone

(571) 294-3557

NPI assigned

Mar 9, 2015

Last updated

Aug 3, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Chavone JohnsonNPI 1851455448

Title

Physical Therapist

Phone

(571) 294-3557

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Chavone Johnson, PT

  • Physical Therapist
  • Fairfax, VA
  • NPI 1851455448

  DC

  Medicare reassignment NPD Authorized official
• Amy Rock, RD

  • Registered Dietitian
  • Fairfax, VA
  • NPI 1497638357
  NPD

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

{
    "created_epoch": "1425859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438560000000",
    "number": "1982097465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3903 FAIR RIDGE DR",
            "address_2": "211",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220332943",
            "telephone_number": "571-294-3557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3903 FAIR RIDGE DR",
            "address_2": "211",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220332943",
            "telephone_number": "571-294-3557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROACTIVE PHYSICAL THERAPY AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-09",
        "last_updated": "2015-08-03",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "CHAVONE",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "571-294-3557",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "VA",
            "license": "2305204873",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Privia Medical Group, LLC
• Privia Medical Group, LLC
• Emily Privott, DPT
• Priya Gupta DDS PC
• Pro Healthcare Servicing, LLC
• Procare Acupuncture and Wellness
• Carin Michelle Procopio, M.S., CCC-SLP
• Sally Proctor, RPH
• Professional Sportscare & Rehab, LLC (Pivot Physical Therapy)
• Proflex Physical Thearpy of Maryland, LLC

• Physical Therapy Clinic/Center in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Physical Therapy Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2015; 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.