Healthcare Provider Details

I. General information

NPI: 1255922589
Provider Name (Legal Business Name): WEIGHT LOSS AND VITALITY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2021
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5904 RICHMOND HWY STE 350
ALEXANDRIA VA
22303-1866
US

IV. Provider business mailing address

5904 RICHMOND HWY STE 350
ALEXANDRIA VA
22303-1866
US

V. Phone/Fax

Practice location:
  • Phone: 571-550-9000
  • Fax:
Mailing address:
  • Phone: 571-550-9000
  • Fax: 571-367-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TANYA WARD
Title or Position: OFFICE MANAGER
Credential:
Phone: 571-248-5191