Healthcare Provider Details

I. General information

NPI: 1376975342
Provider Name (Legal Business Name): JOEY JOHN LAPARAN PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2013
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8320 OLD COURTHOUSE RD SUITE 401
VIENNA VA
22182-3831
US

IV. Provider business mailing address

11240 WAPLES MILL RD SUITE 403
FAIRFAX VA
22030-6078
US

V. Phone/Fax

Practice location:
  • Phone: 703-810-5214
  • Fax: 703-810-5494
Mailing address:
  • Phone: 703-383-6454
  • Fax: 703-810-5494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306603625
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: