Healthcare Provider Details

I. General information

NPI: 1861634610
Provider Name (Legal Business Name): FARHEEN HUSSAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2009
Last Update Date: 08/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8348 TRAFORD LN 200
SPRINGFIELD VA
22152-1663
US

IV. Provider business mailing address

13174 NEW PARKLAND DR
HERNDON VA
20171-3822
US

V. Phone/Fax

Practice location:
  • Phone: 703-568-7500
  • Fax: 703-866-0158
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2305205635
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: