Provider Demographics
NPI:1841546686
Name:TESFAYE, REBKA S (PTA)
Entity type:Individual
Prefix:
First Name:REBKA
Middle Name:S
Last Name:TESFAYE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9701 KINGS CROWN CT
Mailing Address - Street 2:102
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-5006
Mailing Address - Country:US
Mailing Address - Phone:703-405-1519
Mailing Address - Fax:
Practice Address - Street 1:9701 KINGS CROWN CT
Practice Address - Street 2:102
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-5006
Practice Address - Country:US
Practice Address - Phone:703-405-1519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306603348225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant