Healthcare Provider Details

I. General information

NPI: 1255771515
Provider Name (Legal Business Name): HAMID ESPANDYARI PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8316 ARLINGTON BLVD #520
FAIRFAX VA
22031
US

IV. Provider business mailing address

8316 ARLINGTON BLVD #520
FAIRFAX VA
22031
US

V. Phone/Fax

Practice location:
  • Phone: 703-205-1999
  • Fax: 703-205-1911
Mailing address:
  • Phone: 703-205-1999
  • Fax: 703-205-1911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number2305004058
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number230500408
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: