Individual
AMY M DECROO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
10701 MAIN ST, FAIRFAX, VA 22030-6904
(703) 273-7705
Mailing address
10701 MAIN ST, FAIRFAX, VA 22030-6904
(703) 273-7705
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306601231
VA
Other
Enumeration date
10/09/2015
Last updated
04/06/2017
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