Organization
BLUE ROOM PT INC.
Active
Organization
BLUE ROOM PT INC.
Active
Other names
Blue Room Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CONRAD SULTAN OSIPOWICZ (PRESIDENT)
(240) 505-5544
Entity
Organization
Contact information
Practice address
8530 AMANDA PL, VIENNA, VA 22180-6873
(240) 505-5544
(301) 365-4203
Mailing address
13505 DULLES TECHNOLOGY DR, SUITE 2, HERNDON, VA 20171-3401
(240) 505-5544
(301) 365-4203
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
04/26/2017
Last updated
04/26/2017
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