Provider Demographics
NPI:1295409092
Name:ESCUE, MALLOREE DIANNE (DPT)
Entity Type:Individual
Prefix:
First Name:MALLOREE
Middle Name:DIANNE
Last Name:ESCUE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13175 MARINA WAY APT 356
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-1266
Mailing Address - Country:US
Mailing Address - Phone:407-756-8376
Mailing Address - Fax:
Practice Address - Street 1:43330 JUNCTION PLZ STE 122
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-3407
Practice Address - Country:US
Practice Address - Phone:703-972-1040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214542225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist