Healthcare Provider Details

I. General information

NPI: 1417126020
Provider Name (Legal Business Name): ELISSA H FEDEROVICH PT, NCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5249 DUKE ST STE 203
ALEXANDRIA VA
22304-2926
US

IV. Provider business mailing address

3918 TERRACE DR
ANNANDALE VA
22003-1853
US

V. Phone/Fax

Practice location:
  • Phone: 703-751-1733
  • Fax: 703-370-7209
Mailing address:
  • Phone: 703-642-9176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number2305202026
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: