Healthcare Provider Details

I. General information

NPI: 1548259088
Provider Name (Legal Business Name): MARY K HASSELL DPT, OCS, ATC, CSCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 24TH ST
FORT LEE VA
23801-1716
US

IV. Provider business mailing address

700 24TH ST
FORT LEE VA
23801-1716
US

V. Phone/Fax

Practice location:
  • Phone: 804-734-9295
  • Fax: 804-734-9016
Mailing address:
  • Phone: 804-734-9295
  • Fax: 804-734-9016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305203369
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: