Healthcare Provider Details

I. General information

NPI: 1265501589
Provider Name (Legal Business Name): NICOLE R HAMPTON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21475 RIDGETOP CIR SUITE 100
STERLING VA
20166-6580
US

IV. Provider business mailing address

44011 KINGS ARMS SQ
ASHBURN VA
20147-4880
US

V. Phone/Fax

Practice location:
  • Phone: 703-433-2500
  • Fax: 703-433-2558
Mailing address:
  • Phone: 703-433-2500
  • Fax: 703-433-2558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306602054
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: