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General NPI Number Information
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NPI Number | 1841805942
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Entity Type | Individual
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Provider Name | CARLO TIRSO
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Gender | Male
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Dates
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Enumeration Date | 09/15/2020
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Last Update Date | 09/15/2020
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Provider Practice Location Address
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Address Line | 6035 BURKE CENTRE PKWY STE 300
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City | BURKE
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State | VA
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Zip | 22015-3750
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Country | US
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Telephone | 703-978-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 3502 QUEEN ANNE DR
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City | FAIRFAX
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State | VA
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Zip | 22030-1831
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Country | US
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Telephone | 703-402-0816
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305213664
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License Number State | VA
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