# LOUDOUN MEDICAL GROUP, PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** LOUDOUN MEDICAL GROUP, PC
- **Other names:** Optimum Physical Therapy & Sports Medicine
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1619143443
- **Legal business name:** LOUDOUN MEDICAL GROUP, PC
- **Authorized official:** MARY BETH TAMASY (CEO)
- **Authorized official phone:** (703) 737-6010

## Contact information

- **Practice address:** 224-D CORNWALL STREET, NW, SUITE 200, LEESBURG, VA 20176-2700
- **Practice address phone:** (703) 443-2223
- **Practice address fax:** (703) 443-2690
- **Mailing address:** 224-D CORNWALL STREET, NW, SUITE 403, LEESBURG, VA 20176-2704
- **Mailing address phone:** (703) 737-6010
- **Mailing address fax:** (703) 443-8643

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/01/2008
- **Last updated:** 09/26/2022