Provider Demographics
NPI:1164736096
Name:DETER, ALESA JUSTINE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:ALESA
Middle Name:JUSTINE
Last Name:DETER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3026 ROSEMARY LN
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-1841
Mailing Address - Country:US
Mailing Address - Phone:308-672-1812
Mailing Address - Fax:
Practice Address - Street 1:1715 N GEORGE MASON DR
Practice Address - Street 2:SUITE 503
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3609
Practice Address - Country:US
Practice Address - Phone:703-525-5542
Practice Address - Fax:703-525-2739
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052065002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic