Healthcare Provider Details

I. General information

NPI: 1376108514
Provider Name (Legal Business Name): ANNA TESSIATORE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 IRVING ST NW
WASHINGTON DC
20010-2921
US

IV. Provider business mailing address

102 IRVING ST NW
WASHINGTON DC
20010-2921
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-1760
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPT872313
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: