Provider Demographics
NPI:1689213159
Name:FAMILY PHYSICAL THERAPY AND WELLNESS LLC
Entity Type:Organization
Organization Name:FAMILY PHYSICAL THERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAZOKI
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:202-460-8571
Mailing Address - Street 1:10706 ROSEHAVEN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2827
Mailing Address - Country:US
Mailing Address - Phone:202-460-8571
Mailing Address - Fax:
Practice Address - Street 1:2944 HUNTER MILL RD STE 103
Practice Address - Street 2:
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-1761
Practice Address - Country:US
Practice Address - Phone:202-460-8571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-02
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty