Provider Demographics
NPI:1780176230
Name:LY, THANH YEN (ATC)
Entity type:Individual
Prefix:
First Name:THANH
Middle Name:YEN
Last Name:LY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3304 NEVIUS ST
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-1712
Mailing Address - Country:US
Mailing Address - Phone:571-224-6593
Mailing Address - Fax:
Practice Address - Street 1:2960 CHAIN BRIDGE RD STE 201
Practice Address - Street 2:
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-3040
Practice Address - Country:US
Practice Address - Phone:703-242-6460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer