=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861071276
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIN KENNEDY DALISAY PT, DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2021
-----------------------------------------------------
Last Update Date | 04/04/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3044 SILENT VALLEY DR
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22031-2043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-701-9398
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4144
-----------------------------------------------------
City | MERRIFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22116-4144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number | 2305212996
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------