Healthcare Provider Details

I. General information

NPI: 1902312671
Provider Name (Legal Business Name): CATHY ANGELA EYI-MENSAH DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2017
Last Update Date: 12/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 VIRGINIA AVE
ALEXANDRIA VA
22302-3200
US

IV. Provider business mailing address

5705 WOODLAWN GREEN CIR APT L
ALEXANDRIA VA
22309-4611
US

V. Phone/Fax

Practice location:
  • Phone: 703-684-9100
  • Fax:
Mailing address:
  • Phone: 703-593-9808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305211413
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: