Provider Demographics
NPI:1639425242
Name:UMAYAM, FEDERICO A II (PT)
Entity Type:Individual
Prefix:
First Name:FEDERICO
Middle Name:A
Last Name:UMAYAM
Suffix:II
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 1:5252 LYNGATE CT
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1672
Mailing Address - Country:US
Mailing Address - Phone:703-239-2300
Mailing Address - Fax:703-239-2301
Practice Address - Street 1:267 GARRISONVILLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1596
Practice Address - Country:US
Practice Address - Phone:540-288-9761
Practice Address - Fax:540-288-9764
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207417225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAK949 - 0035OtherCAREFIRST