Provider Demographics
NPI:1831263623
Name:DEBORAH ABDOW-ADDIS DBA PEDIATRIC PHYSICAL THERAPY SERVICES
Entity type:Organization
Organization Name:DEBORAH ABDOW-ADDIS DBA PEDIATRIC PHYSICAL THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ABDOW-ADDIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT,MS
Authorized Official - Phone:703-242-1921
Mailing Address - Street 1:407 CHURCH ST NE STE D
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4737
Mailing Address - Country:US
Mailing Address - Phone:703-242-1921
Mailing Address - Fax:703-242-1922
Practice Address - Street 1:407 CHURCH ST NE STE D
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4737
Practice Address - Country:US
Practice Address - Phone:703-242-1921
Practice Address - Fax:703-242-1922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2014-10-29
Deactivation Date:2008-07-28
Deactivation Code:
Reactivation Date:2014-10-29
Provider Licenses
StateLicense IDTaxonomies
MD15227225100000X
VA2305002051225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty