Individual
CARLO TIRSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6035 BURKE CENTRE PKWY STE 300, BURKE, VA 22015-3750
(703) 978-3300
Mailing address
3502 QUEEN ANNE DR, FAIRFAX, VA 22030-1831
(703) 402-0816
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305213664
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2305213664
VIRGINIA DEPARTMENT OF HEALTH/ PHYSICAL THERAPY LICENSE
VA
Enumeration date
09/15/2020
Last updated
09/15/2020
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