Provider Demographics
NPI:1407070394
Name:FLIAKAS, ALYSON PETRUCCI (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:ALYSON
Middle Name:PETRUCCI
Last Name:FLIAKAS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MRS
Other - First Name:ALYSON
Other - Middle Name:BROOKE
Other - Last Name:PETRUCCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:1635 N GEORGE MASON DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3601
Mailing Address - Country:US
Mailing Address - Phone:703-810-5216
Mailing Address - Fax:703-522-3253
Practice Address - Street 1:1635 N GEORGE MASON DR
Practice Address - Street 2:SUITE 110
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3601
Practice Address - Country:US
Practice Address - Phone:703-810-5216
Practice Address - Fax:703-522-3253
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203364225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA496681Medicare ID - Type Unspecified