Provider Demographics
NPI:1619065117
Name:MASIELLO, LOIS ANN (MPT)
Entity Type:Individual
Prefix:MS
First Name:LOIS
Middle Name:ANN
Last Name:MASIELLO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11503 WILDFLOWER CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5805
Mailing Address - Country:US
Mailing Address - Phone:703-856-2003
Mailing Address - Fax:
Practice Address - Street 1:9010 HORNBAKER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-3963
Practice Address - Country:US
Practice Address - Phone:703-361-9677
Practice Address - Fax:703-361-9678
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23050060572251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic