Basic Information
| Provider Information | |||||||||
| NPI: | 1154756682 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TROSCH | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6225 BRANDON AVE STE 130 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221502519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035697500 | ||||||||
| FaxNumber: | 7038550518 | ||||||||
| Practice Location | |||||||||
| Address1: | 6225 BRANDON AVE STE 130 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221502519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035697500 | ||||||||
| FaxNumber: | 7038550518 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2013 | ||||||||
| LastUpdateDate: | 10/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251P0200X | PTT28619 | FL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | 2251P0200X | PT26379 | FL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | 225100000X | 2305212969 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 010029500 | 05 | FL | MEDICAID |