Provider Demographics
NPI:1033748272
Name:OSOWSKI, AMY JEAN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:JEAN
Last Name:OSOWSKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12524 PHILMONT DR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170
Mailing Address - Country:US
Mailing Address - Phone:703-399-0441
Mailing Address - Fax:
Practice Address - Street 1:RIDE ON RANCH
Practice Address - Street 2:38416 MORRISONVILLE RD.
Practice Address - City:LOVESTTVILLE
Practice Address - State:VA
Practice Address - Zip Code:20180
Practice Address - Country:US
Practice Address - Phone:703-298-5319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPI60803824225200000X
VA2306601471225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant