Basic Information
| Provider Information | |||||||||
| NPI: | 1710642590 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | DRIESSEN | ||||||||
| FirstName: | AMY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 715868 | ||||||||
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| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191715868 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8049151910 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8270 WILLOW OAKS CORPORATE DR STE 700 | ||||||||
| Address2: | |||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220314529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038105218 | ||||||||
| FaxNumber: | 7038105406 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2021 | ||||||||
| LastUpdateDate: | 10/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 2305214958 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.