LAKE RIDGE PHYSICAL THERAPY, LLC. (NPI# 1144404039) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144404039 |
| Entity Type | Organization |
| Organization Name | LAKE RIDGE PHYSICAL THERAPY, LLC. |
| Other Organization Name | MONTCLAIR PHYSICAL THERAPY |
| Practice Address |
5139 Waterway Dr Montclair VA 22025-1261 |
| Mailing Address |
12544 Dillingham Sq Woodbridge VA 22192-5259 |
| Practice Telephone | 7037306400 |
| Practice Fax Number | 7037309212 |
| Mailing Telephone | 7037306969 |
| Mailing Fax Number | 7037301169 |
| Enumeration Date | 2007-12-27 |
| Last Update Date | 2007-12-27 |
| Authorized Official Name | GARY F BAKER (INSURANCE SPECIALIST) |
| Authorized Official Telephone | 7037306969 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 225100000X | Physical Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | ANTHEM BC/BS | 197803 | 01 |
| VA | ACN | 685023 | 01 |
| VA | AETNA | 7711124 | 01 |
| Other Name | Type Code |
|---|---|
| Montclair Physical Therapy | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871598417 | Lake Ridge Physical Therapy, LLC. | Physical Therapist | 12544 Dillingham Sq, Woodbridge, VA 22192-5259 | 2005-06-20 |
| 1447434253 | Lake Ridge Physical Therapy, LLC. | Physical Therapist | 4229 Lafayette Center Drive, Suite 1250, Chantilly, VA 20151 | 2007-12-28 |
| Street Address |
5139 WATERWAY DR |
| City | MONTCLAIR |
| State | VA |
| Zip Code | 22025-1261 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023622230 | Joanne Perdu-ouimet | Behavioral Analyst | Incredible Changes, 4191 Waterway Dr., Dumfries, VA 22025 | 2020-09-04 |
| 1194287524 | Above and Beyond Therapy LLC | Speech-Language Pathologist | 15389 Autum Ln, Dumfries, VA 22025 | 2019-04-04 |
| 1669954095 | Renee L Roberts | Registered Nurse | 4222 Fortuna Center Plaza Ste 280, Dumfries, VA 22025 | 2018-09-01 |
| 1689044869 | Tracy Agyeman-badu | Pharmacist | 4310 Fortuna Village Center Plaza, Dumfries, VA 22025 | 2015-10-01 |
| 1588054316 | Tiffany Washington | Pharmacy Technician | 16224 Taconic Cir, Dumfries, VA 22025 | 2015-02-02 |
| 1568706158 | Boulevard Center Pediatrics | Pediatrics | 3733 Fettler Park Dr., Dumfries, VA 22025 | 2012-11-20 |
| 1205111796 | Khanh T Le | Pharmacist | 17506 Cajun Ct, Dumfries, VA 22025 | 2011-10-15 |
| 1679737761 | Shailesh K Gohel | Pediatrics | 3733 Fettler Park Dr, Dumfries, VA 22025 | 2008-07-17 |
| 1376616268 | Douglas Kendrick Chan | Physical Therapist | 3767 Fettler Park Drive, Dumfries, VA 22025 | 2006-11-16 |
| 1861596454 | Paul Wells Conrad | Dentist | 16150 Country Club Drive, Dumfries, VA 22025 | 2006-09-12 |
| Find all providers in zip 22025 | ||||
| Taxonomy Code | 225100000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Physical Therapist |
| (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT’s assess joint motion, muscle strength and endurance, function of heart and lungs, and performance of activities required in daily living, among other responsibilities. Treatment includes therapeutic exercises, cardiovascular endurance training, and training in activities of daily living. (2) A physical therapist is a person qualified by an accredited program in physical therapy, licensed by the state, and practicing within the scope of that license. Physical therapists treat disease, injury, or loss of a bodily part by physical means, such as the application of light, heat, cold, water, electricity, massage and exercise. They develop treatment plans based upon each patient’s strengths, weaknesses, range of motion and ability to function. (3) A health professional who specializes in physical therapy- the health care field concerned primarily with the treatment of disorders with physical agents and methods, such as massage, manipulation, therapeutic exercises, cold, heat (including short-wave, microwave, and ultrasonic diathermy), hydrotherapy, electric stimulation and light to assist in rehabilitating patients and in restoring normal function after an illness or injury. |
| Notes: Source: (1) APTA Guidelines for Physical Therapy Claims Review, American Physical Therapy Association. (3) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 612 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336755560 | Camille Fabis | Physical Therapist | 4247 Vals Way, Montclair, VA 22025-1140 | 2020-09-22 |
| 1194338814 | Blueprint Physical Therapy and Wellness LLC | Physical Therapist | 13 Wilfred St Apt 2, Montclair, NJ 07042-1643 | 2020-08-24 |
| 1316561673 | Alisa Meghani | Physical Therapist | 30 Mission St Apt 2, Montclair, NJ 07042-4518 | 2020-06-02 |
| 1780196014 | Jasmine Scarborough | Physical Therapist | 49 Claremont Ave Ste 5, Montclair, NJ 07042-4854 | 2017-10-26 |
| 1932625316 | Ryan William Goodell | Physical Therapist | 45 Church St Apt D-12, Montclair, NJ 07042-2733 | 2017-08-17 |
| 1023444817 | Laura Ann Crandall | Physical Therapist | 267 Park St, Montclair, NJ 07043-1732 | 2013-09-24 |
| 1487905444 | Russell K. Ditchfield-agboh | Physical Therapist | 141 Walnut St Apt 2, Montclair, NJ 07042-3885 | 2012-09-30 |
| 1225266448 | Lavosky Physical Therapy & Consulting, LLC | Physical Therapist | 22 Euclid Pl, Montclair, NJ 07042-5022 | 2009-06-25 |
| 1366635633 | Frank M Failla | Physical Therapist | 193 Bellevue Ave, Montclair, NJ 07043-1820 | 2007-08-21 |
| 1053510362 | Jane Ellen Alsen | Physical Therapist | 37 Cambridge Rd, Montclair, NJ 07042-5003 | 2007-07-16 |
| Find all providers in MONTCLAIR | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.