Healthcare Provider Details

I. General information

NPI: 1851590202
Provider Name (Legal Business Name): TIEYA M QUALLS PT, DPT, PRPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 ORONOCO STREET
ALEXANDRIA VA
22314-2091
US

IV. Provider business mailing address

14605 ELM ST UNIT 1821
UPPER MARLBORO MD
20773-7567
US

V. Phone/Fax

Practice location:
  • Phone: 301-246-2353
  • Fax: 240-241-6412
Mailing address:
  • Phone: 301-246-2353
  • Fax: 240-241-6412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305213523
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT870745
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number21779
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: