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General NPI Number Information
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NPI Number | 1275918435
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Entity Type | Organization
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Legal Business Name | FOUNDATION FITNESS OF ANNANDALE
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Dates
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Enumeration Date | 07/29/2015
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Last Update Date | 07/29/2015
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Provider Practice Location Address
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Address Line | 7232 COLUMBIA PIKE
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City | ANNANDALE
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State | VA
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Zip | 22003-3145
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Country | US
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Telephone | 703-586-5833
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Fax |
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Provider Business Mailing Address
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Address Line | 7232 COLUMBIA PIKE
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City | ANNANDALE
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State | VA
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Zip | 22003-3145
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Country | US
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Telephone | 703-586-5833
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. PATRICK STEPHEN BRESLEY
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Credential | CPT
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Telephone | 703-586-5833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 255A2300X
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License Number State | VA
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