Provider Demographics
NPI:1205805058
Name:PRISHACK, ANDREW ANTHONY (PT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:ANTHONY
Last Name:PRISHACK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4306 GENERAL KEARNY CT
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1322
Mailing Address - Country:US
Mailing Address - Phone:703-955-0235
Mailing Address - Fax:
Practice Address - Street 1:11230 WAPLES MILL RD
Practice Address - Street 2:SUITE 130
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6087
Practice Address - Country:US
Practice Address - Phone:703-273-2400
Practice Address - Fax:703-691-1486
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204089225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist