Provider Demographics
NPI:1053613828
Name:MAINSPRING PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:MAINSPRING PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:CICHOSZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-463-4665
Mailing Address - Street 1:402 W BROAD ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3337
Mailing Address - Country:US
Mailing Address - Phone:240-463-4665
Mailing Address - Fax:
Practice Address - Street 1:402 W BROAD ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3337
Practice Address - Country:US
Practice Address - Phone:240-463-4665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305005347225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty