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General NPI Number Information
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NPI Number | 1194190421
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Entity Type | Individual
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Provider Name | RACHEL MELISSA FAMA PTA
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Gender | Female
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Dates
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Enumeration Date | 12/11/2015
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Last Update Date | 02/11/2019
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Provider Practice Location Address
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Address Line | 1936 OPITZ BLVD STE A
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3360
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Country | US
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Telephone | 540-841-4443
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Fax |
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Provider Business Mailing Address
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Address Line | 11657 CHARTER OAK CT APT 201
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City | RESTON
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State | VA
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Zip | 20190-4531
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Country | US
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Telephone | 585-944-0228
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2306605075
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License Number State | VA
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