Healthcare Provider Details

I. General information

NPI: 1023744232
Provider Name (Legal Business Name): MAGDALENA MALGORZATA WYSZOGRODZKA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 ARLINGTON BLVD STE 110
FAIRFAX VA
22031-4625
US

IV. Provider business mailing address

2202 KINGS GARDEN WAY
FALLS CHURCH VA
22043-2565
US

V. Phone/Fax

Practice location:
  • Phone: 703-205-1919
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305215207
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: