Provider Demographics
NPI:1598358335
Name:HASAN, ABDUL (PT)
Entity Type:Individual
Prefix:
First Name:ABDUL
Middle Name:
Last Name:HASAN
Suffix:
Gender:M
Credentials:PT
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 1769
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20118-1769
Mailing Address - Country:US
Mailing Address - Phone:571-351-5618
Mailing Address - Fax:571-351-5619
Practice Address - Street 1:10517 BRADDOCK RD STE D
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22032-2275
Practice Address - Country:US
Practice Address - Phone:571-351-5618
Practice Address - Fax:571-351-5619
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214187225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist