Healthcare Provider Details

I. General information

NPI: 1174167878
Provider Name (Legal Business Name): TAYLOR REHFUSS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2019
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45155 RESEARCH PL STE 140
ASHBURN VA
20147-4193
US

IV. Provider business mailing address

45155 RESEARCH PL STE 140
ASHBURN VA
20147-4193
US

V. Phone/Fax

Practice location:
  • Phone: 703-858-0500
  • Fax:
Mailing address:
  • Phone: 703-858-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110-006930
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: