MEDICARE: LANIA CHARITY

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	A4465	MD
2	225200000X	Physical Therapy Assistant	2306604374	VA

General Provider Information

NPI Number	:	1821542515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANIA CHARITY

Provider Business Mailing Address
First Line	:	4310 FOREST HILL DR
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22030-5680
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4310 FOREST HILL DR
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22030-5680
Country	:	US
Telephone Number	:	703-278-1001
Fax Number	:

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

Provider Enumeration Date	:	08/10/2016
Last Update Date	:	08/10/2016

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Directions to “ LANIA CHARITY ” Practice Location

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