Provider Demographics
NPI:1750415642
Name:MERSHA, RIBCA BISSRAT
Entity type:Individual
Prefix:MRS
First Name:RIBCA
Middle Name:BISSRAT
Last Name:MERSHA
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 1:5012 GAINSBOROUGH DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-2319
Mailing Address - Country:US
Mailing Address - Phone:703-323-1370
Mailing Address - Fax:703-250-1213
Practice Address - Street 1:9642 BURKE LAKE RD
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-3024
Practice Address - Country:US
Practice Address - Phone:703-425-1698
Practice Address - Fax:703-425-1311
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305004604225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist