1043238215 NPI number — MRS. PHYLLIS ANN FLEETWOOD PT,MS,OCS

Table of content: MS. CYNTHIA ALVAREZ RADT (NPI 1073014825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043238215 NPI number — MRS. PHYLLIS ANN FLEETWOOD PT,MS,OCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLEETWOOD
Provider First Name:
PHYLLIS
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT,MS,OCS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043238215
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
42660 LEGACY PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRAMBLETON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20148-6956
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-327-5193
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 MONTGOMERY ST STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22314-1560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-548-0087
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2305202377 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2026 www.npivalidator.com