Provider Demographics
NPI:1790399368
Name:QUAYLE, ANNA MARIA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIA
Last Name:QUAYLE
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 1:6509 BERKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-3053
Mailing Address - Country:US
Mailing Address - Phone:614-357-1130
Mailing Address - Fax:
Practice Address - Street 1:6509 BERKSHIRE DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3053
Practice Address - Country:US
Practice Address - Phone:614-357-1130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019017820225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist