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NPI Code Detail

MEDICARE: EDINA LULUSHI PTA

MEDICARE: EDINA LULUSHI 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
1225200000XPhysical Therapy Assistant2306604793VA

General Provider Information

NPI Number : 1952812703
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDINA LULUSHI PTA
Provider Business Mailing Address
First Line : 7700 BERTITO LN
Second Line :
City : SPRINGFIELD
State : VA
Zip : 22153-1602
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7116 FORT HUNT RD
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22307-1900
Country : US
Telephone Number : 703-768-0234
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2017
Last Update Date : 10/19/2017

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