Provider Demographics
NPI:1003613472
Name:GEBREHIWOT, AVIAD B (PT, DPT, MS, CSCS)
Entity type:Individual
Prefix:
First Name:AVIAD
Middle Name:B
Last Name:GEBREHIWOT
Suffix:
Gender:M
Credentials:PT, DPT, MS, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6240 INDIAN RUN PKWY
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-6438
Mailing Address - Country:US
Mailing Address - Phone:703-582-8549
Mailing Address - Fax:
Practice Address - Street 1:4059 JANDY BLVD
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-8819
Practice Address - Country:US
Practice Address - Phone:484-503-6465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT033142225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist