Healthcare Provider Details

I. General information

NPI: 1699878637
Provider Name (Legal Business Name): ANA YANCI ALAS MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6506 LOISDALE RD SUITE 300
SPRINGFIELD VA
22150-1824
US

IV. Provider business mailing address

8025 STEADMAN ST
ALEXANDRIA VA
22309-1120
US

V. Phone/Fax

Practice location:
  • Phone: 703-924-4100
  • Fax: 703-922-0638
Mailing address:
  • Phone: 703-799-6667
  • Fax: 703-922-0638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2305203751
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: