Provider Demographics
NPI:1851400402
Name:KASSIS, NATHALIE G (PT)
Entity Type:Individual
Prefix:
First Name:NATHALIE
Middle Name:G
Last Name:KASSIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5008 DOMAIN PL
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-5016
Mailing Address - Country:US
Mailing Address - Phone:703-671-7707
Mailing Address - Fax:
Practice Address - Street 1:5618 OX RD
Practice Address - Street 2:SUITE H
Practice Address - City:FAIRFAX STATION
Practice Address - State:VA
Practice Address - Zip Code:22039-1018
Practice Address - Country:US
Practice Address - Phone:703-426-4949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2305201771OtherLICENSE#