Healthcare Provider Details

I. General information

NPI: 1003413717
Provider Name (Legal Business Name): DAPHNE MONIQUE BATISTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24600 MILLSTREAM DR STE 380
STONE RIDGE VA
20105-5686
US

IV. Provider business mailing address

24600 MILLSTREAM DR STE 380
ALDIE VA
20105-5686
US

V. Phone/Fax

Practice location:
  • Phone: 703-810-5241
  • Fax:
Mailing address:
  • Phone: 703-810-5285
  • Fax: 571-407-5694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: