Healthcare Provider Details

I. General information

NPI: 1164736096
Provider Name (Legal Business Name): ALESA JUSTINE DETER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2010
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10135 COLVIN RUN RD STE 100
GREAT FALLS VA
22066-1872
US

IV. Provider business mailing address

3026 ROSEMARY LN
FALLS CHURCH VA
22042-1841
US

V. Phone/Fax

Practice location:
  • Phone: 703-621-0962
  • Fax:
Mailing address:
  • Phone: 308-672-1812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2305206500
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: