Provider Demographics
NPI:1669454641
Name:HOSSEINI, MARY ESSIG
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ESSIG
Last Name:HOSSEINI
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 1:14535 JOHN MARSHALL HWY
Mailing Address - Street 2:STE 203
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-3839
Mailing Address - Country:US
Mailing Address - Phone:703-753-0974
Mailing Address - Fax:703-753-9709
Practice Address - Street 1:14535 JOHN MARSHALL HIGHWAY
Practice Address - Street 2:SUITE 203
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155
Practice Address - Country:US
Practice Address - Phone:703-753-0974
Practice Address - Fax:703-753-9709
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305003902225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005977A23Medicare ID - Type Unspecified
Q29868Medicare UPIN