Individual
VI PHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
14935 HOLLY KNOLL LN, GAINESVILLE, VA 20155-4899
(703) 743-3999
Mailing address
6143 CAMERONS FERRY DR, HAYMARKET, VA 20169-3328
(717) 507-6863
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0131001936
VA
Other
Enumeration date
04/24/2020
Last updated
04/24/2020
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