Healthcare Provider Details

I. General information

NPI: 1669351227
Provider Name (Legal Business Name): ABIGAIL ALTIMONDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10260 MAIN ST
FAIRFAX VA
22030-2404
US

IV. Provider business mailing address

2105 N GLEBE RD UNIT 1320
ARLINGTON VA
22207-2238
US

V. Phone/Fax

Practice location:
  • Phone: 571-279-6844
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305217379
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: