Healthcare Provider Details

I. General information

NPI: 1639001720
Provider Name (Legal Business Name): EVAN BRANDON FILONCZUK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8612 FOXBERRY DR
NORTH CHESTERFIELD VA
23235-6506
US

IV. Provider business mailing address

8612 FOXBERRY DR
NORTH CHESTERFIELD VA
23235-6506
US

V. Phone/Fax

Practice location:
  • Phone: 818-451-5064
  • Fax:
Mailing address:
  • Phone: 818-451-5064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306605498
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: