Provider Demographics
NPI:1275668808
Name:ELKASSED, FAROUK (DPT)
Entity Type:Individual
Prefix:
First Name:FAROUK
Middle Name:
Last Name:ELKASSED
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 1:10340 DEMOCRACY LN
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2518
Mailing Address - Country:US
Mailing Address - Phone:703-865-5538
Mailing Address - Fax:
Practice Address - Street 1:10340 DEMOCRACY LN
Practice Address - Street 2:SUITE 106
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2518
Practice Address - Country:US
Practice Address - Phone:703-865-5538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305004573225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
152285Medicare UPIN