Healthcare Provider Details

I. General information

NPI: 1457430779
Provider Name (Legal Business Name): MELANIE J ESCOBAR MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3998 FAIR RIDGE DR STE 125
FAIRFAX VA
22033-2908
US

IV. Provider business mailing address

5300 HICKORY PARK DR STE 230
GLEN ALLEN VA
23059-2629
US

V. Phone/Fax

Practice location:
  • Phone: 703-865-7680
  • Fax: 703-865-7683
Mailing address:
  • Phone: 804-756-8495
  • Fax: 804-270-3597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305202149
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: