MEDICARE: EUNSIL CHOI PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	2306604952	VA

General Provider Information

NPI Number	:	1396245676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUNSIL CHOI PTA

Provider Business Mailing Address
First Line	:	4713 BIDEFORD SQ
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22030-6160
Country	:	US
Telephone Number	:	605-691-1660
Fax Number	:

Provider Business Practice Location Address
First Line	:	4304 EVERGREEN LN STE 102
Second Line	:
City	:	ANNANDALE
State	:	VA
Zip	:	22003-3216
Country	:	US
Telephone Number	:	703-256-7979
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2018
Last Update Date	:	03/17/2018

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Directions to “ EUNSIL CHOI PTA” Practice Location

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