Provider Demographics
NPI:1760715932
Name:MISITZIS, ASHLEY (DPT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:MISITZIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7201 BELTON CT
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-5056
Mailing Address - Country:US
Mailing Address - Phone:703-943-0577
Mailing Address - Fax:
Practice Address - Street 1:7201 BELTON CT
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-5056
Practice Address - Country:US
Practice Address - Phone:703-943-0577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-04
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206093225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist