MEDICARE: NATHALIE G KASSIS PT

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	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2305201771	OTHER	VA	LICENSE#

General Provider Information

NPI Number	:	1851400402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHALIE G KASSIS PT

Provider Business Mailing Address
First Line	:	5008 DOMAIN PL
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22311-5016
Country	:	US
Telephone Number	:	703-671-7707
Fax Number	:

Provider Business Practice Location Address
First Line	:	5618 OX RD
Second Line	:	SUITE H
City	:	FAIRFAX STATION
State	:	VA
Zip	:	22039-1018
Country	:	US
Telephone Number	:	703-426-4949
Fax Number	:

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	11/19/2007

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