Provider Demographics
NPI:1598302846
Name:KAZI, TAMANNA
Entity Type:Individual
Prefix:
First Name:TAMANNA
Middle Name:
Last Name:KAZI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6746 METROPOLITAN CENTER DR APT 204
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-4582
Mailing Address - Country:US
Mailing Address - Phone:703-679-0050
Mailing Address - Fax:
Practice Address - Street 1:6746 METROPOLITAN CENTER DR APT 204
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-4582
Practice Address - Country:US
Practice Address - Phone:703-679-0050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA20192255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty