Provider Demographics
NPI:1376329821
Name:O'MASTA, AMY (ATC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:O'MASTA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8270 WILLOW OAKS CORPORATE DRIVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031
Mailing Address - Country:US
Mailing Address - Phone:709-810-5228
Mailing Address - Fax:571-407-5659
Practice Address - Street 1:8270 WILLOW OAKS CORPORATE DRIVE
Practice Address - Street 2:SUITE 700
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031
Practice Address - Country:US
Practice Address - Phone:709-810-5228
Practice Address - Fax:571-407-5659
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01260027322255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer