Provider Demographics
NPI:1497704407
Name:FERRAMOSCA, NICHOLINA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:NICHOLINA
Middle Name:
Last Name:FERRAMOSCA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 741465
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-0484
Mailing Address - Country:US
Mailing Address - Phone:703-709-1116
Mailing Address - Fax:703-709-5134
Practice Address - Street 1:1831 WIEHLE AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190
Practice Address - Country:US
Practice Address - Phone:703-709-1116
Practice Address - Fax:703-709-5134
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203339225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
019135T99Medicare Oscar/Certification
VAPTAN132094Medicare PIN