Provider Demographics
NPI:1821259565
Name:YIMAM, ALIYAT
Entity Type:Individual
Prefix:
First Name:ALIYAT
Middle Name:
Last Name:YIMAM
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 1:7710 CUMBERTREE CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22153-2165
Mailing Address - Country:US
Mailing Address - Phone:202-870-4996
Mailing Address - Fax:
Practice Address - Street 1:20 PIDGEON HILL DR
Practice Address - Street 2:STE 103
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-6134
Practice Address - Country:US
Practice Address - Phone:202-870-4996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22388225100000X
DCPT870843225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist