Healthcare Provider Details

I. General information

NPI: 1730687484
Provider Name (Legal Business Name): HEAD, SHOULDERS, KNEES AND TOES PT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2018
Last Update Date: 01/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5437 20TH ST N
ARLINGTON VA
22205-3020
US

IV. Provider business mailing address

5437 20TH ST N
ARLINGTON VA
22205-3020
US

V. Phone/Fax

Practice location:
  • Phone: 703-868-0628
  • Fax: 703-536-5391
Mailing address:
  • Phone: 703-868-0628
  • Fax: 703-536-5391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2305203364
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number2305203364
License Number StateVA

VIII. Authorized Official

Name: ALYSON FLIAKAS
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: MSPT
Phone: 703-868-0628