Individual
LIDA THANARAK PITSCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, PTA
Contact information
Practice address
42012 DONNINGTON PL, ASHBURN, VA 20148-8011
(703) 593-7966
Mailing address
42012 DONNINGTON PL, ASHBURN, VA 20148-8011
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
2306601644
VA
2255A2300X
Athletic Trainer
Primary
0126000614
VA
Other
Enumeration date
01/12/2013
Last updated
11/30/2014
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