Provider Demographics
NPI:1851558316
Name:MANDEL, ABBY (PT)
Entity Type:Individual
Prefix:MS
First Name:ABBY
Middle Name:
Last Name:MANDEL
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 1:2041 FREEDOM LN
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-1805
Mailing Address - Country:US
Mailing Address - Phone:703-241-2122
Mailing Address - Fax:703-237-9236
Practice Address - Street 1:2041 FREEDOM LN
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-1805
Practice Address - Country:US
Practice Address - Phone:703-241-2122
Practice Address - Fax:703-237-9236
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305001395225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG880OtherCARE FIRST BLUE CROSS BLUE SHIELD
VA491038Medicare PIN