Healthcare Provider Details

I. General information

NPI: 1215062047
Provider Name (Legal Business Name): ELLYN SARTUCCI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELLYN DUNFORD

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8348 TRAFORD LN SUITE 200
SPRINGFIELD VA
22152-1663
US

IV. Provider business mailing address

8205 CHOLLMAN CT
ALEXANDRIA VA
22308-1701
US

V. Phone/Fax

Practice location:
  • Phone: 703-569-7500
  • Fax: 703-866-0158
Mailing address:
  • Phone: 703-347-6355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2305002031
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: