Healthcare Provider Details

I. General information

NPI: 1205437167
Provider Name (Legal Business Name): ASOUFY THERAPY SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 SAINT ANDREWS REACH APT A
CHESAPEAKE VA
23320-8587
US

IV. Provider business mailing address

916 SAINT ANDREWS REACH APT A
CHESAPEAKE VA
23320-8587
US

V. Phone/Fax

Practice location:
  • Phone: 734-239-5791
  • Fax:
Mailing address:
  • Phone: 734-239-5791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. WIDAD ASOUFY
Title or Position: OWNER/AUTHORIZED OFFICIAL
Credential: OTRL
Phone: 734-239-5791