Healthcare Provider Details

I. General information

NPI: 1669454641
Provider Name (Legal Business Name): MRS. MARY ESSIG HOSSEINI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14535 JOHN MARSHALL HIGHWAY SUITE 203
GAINESVILLE VA
20155
US

IV. Provider business mailing address

14535 JOHN MARSHALL HWY STE 203
GAINESVILLE VA
20155-3839
US

V. Phone/Fax

Practice location:
  • Phone: 703-753-0974
  • Fax: 703-753-9709
Mailing address:
  • Phone: 703-753-0974
  • Fax: 703-753-9709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305003902
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: