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General NPI Number Information
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NPI Number | 1902352164
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Entity Type | Individual
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Provider Name | AMY KORCSMAROS
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Gender | Female
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Dates
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Enumeration Date | 08/28/2016
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Last Update Date | 04/28/2021
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Provider Practice Location Address
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Address Line | 8100 INNOVATION PARK DR STE LL20
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City | FAIRFAX
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State | VA
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Zip | 22031-4870
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Country | US
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Telephone | 571-472-0490
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Fax | 571-472-0491
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Provider Business Mailing Address
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Address Line | 8100 INNOVATION PARK DR STE LL20
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City | FAIRFAX
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State | VA
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Zip | 22031-4870
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Country | US
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Telephone | 571-472-0490
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Fax | 571-472-0491
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305214067
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License Number State | VA
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