Basic Information
| Provider Information | |||||||||
| NPI: | 1669454641 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOSSEINI | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | ESSIG | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14535 JOHN MARSHALL HWY | ||||||||
| Address2: | STE 203 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201553839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037530974 | ||||||||
| FaxNumber: | 7037539709 | ||||||||
| Practice Location | |||||||||
| Address1: | 14535 JOHN MARSHALL HIGHWAY | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 20155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037530974 | ||||||||
| FaxNumber: | 7037539709 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305003902 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.