Provider Demographics
NPI:1215033634
Name:MOSTAFA, AHMED HASSAN (DPT)
Entity Type:Individual
Prefix:DR
First Name:AHMED
Middle Name:HASSAN
Last Name:MOSTAFA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5029 BACKLICK RD STE A
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-6044
Mailing Address - Country:US
Mailing Address - Phone:703-333-5288
Mailing Address - Fax:703-333-5952
Practice Address - Street 1:5029 BACKLICK RD STE A
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-6044
Practice Address - Country:US
Practice Address - Phone:703-333-5288
Practice Address - Fax:703-333-5952
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204086225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist