Basic Information
| Provider Information | |||||||||
| NPI: | 1508322355 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEIR | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | ANNELISE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 MASSACHUSETTS AVE NW STE C500 | ||||||||
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| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200011430 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 8101 HINSON FARM RD STE 401 | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223063409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7036647660 | ||||||||
| FaxNumber: | 7036647663 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2019 | ||||||||
| LastUpdateDate: | 04/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305212606 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.