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NPI Code Detail

MEDICARE: AMY DRIESSEN

MEDICARE: AMY DRIESSEN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist
2225100000XPhysical Therapist2305214958VA

General Provider Information

NPI Number : 1710642590
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY DRIESSEN
Provider Business Mailing Address
First Line : PO BOX 715868
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19171-5868
Country : US
Telephone Number : 804-915-1910
Fax Number :
Provider Business Practice Location Address
First Line : 8270 WILLOW OAKS CORPORATE DR STE 700
Second Line :
City : FAIRFAX
State : VA
Zip : 22031-4529
Country : US
Telephone Number : 703-810-5218
Fax Number : 703-810-5406
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2021
Last Update Date : 10/19/2022

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