Organization
EVERGREEN CLINIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JACQUELINE STILES DPT (PHYSICAL THERAPIST)
(443) 622-9641
Entity
Organization
Contact information
Practice address
14540 JOHN MARSHALL HWY STE 202, GAINESVILLE, VA 20155-1693
(703) 753-9700
(703) 753-9701
Mailing address
15670 HUNTON LN, HAYMARKET, VA 20169-1733
(443) 622-9641
(703) 753-9701
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305209030
VA
Other
Enumeration date
07/13/2017
Last updated
07/13/2017
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