Individual
HADI FATHALIKHANI
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
12546 DILLINGHAM SQ, # 101, WOODBRIDGE, VA 22192-5259
(703) 730-6969
(703) 730-1169
Mailing address
14014 SULLYFIELD CIR, STE B, CHANTILLY, VA 20151-1689
(703) 263-2020
(703) 263-2015
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305003984
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
265661
ANTHEM PROVIDER NUMBER
VA
01
—
519289
MAMSI PROVIDER NUMBER
VA
01
—
S427-0001
CAREFIRST BCBS PROVIDER #
VA
Enumeration date
06/20/2005
Last updated
07/08/2007
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