Provider Demographics
NPI:1174857650
Name:FISHBURN, DANIELLE A (DPT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:A
Last Name:FISHBURN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11240 WAPLES MILL RD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6078
Mailing Address - Country:US
Mailing Address - Phone:703-383-6454
Mailing Address - Fax:703-691-4933
Practice Address - Street 1:1850 TOWN CENTER PKWY
Practice Address - Street 2:SUITE 403
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3219
Practice Address - Country:US
Practice Address - Phone:703-810-5203
Practice Address - Fax:703-691-4933
Is Sole Proprietor?:No
Enumeration Date:2009-09-30
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2305206164225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist