Individual
MRS. ELISKA AMYX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
11645 CAPTAIN RHETT LN, FAIRFAX STATION, VA 22039-1235
(703) 401-1191
Mailing address
11645 CAPTAIN RHETT LN, FAIRFAX STATION, VA 22039-1235
(703) 401-1191
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306603116
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
225200000X
EMPLOYER
VA
Enumeration date
11/16/2011
Last updated
12/06/2011
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