Provider Demographics
NPI:1912155425
Name:OSBORNE, IVONE CORVALAN (CMT)
Entity Type:Individual
Prefix:MRS
First Name:IVONE
Middle Name:CORVALAN
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11441 FOGARTY CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-8555
Mailing Address - Country:US
Mailing Address - Phone:240-476-8224
Mailing Address - Fax:703-272-7579
Practice Address - Street 1:8550 ARLINGTON BLVD STE 325
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4647
Practice Address - Country:US
Practice Address - Phone:703-698-7117
Practice Address - Fax:703-698-5729
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019005149225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist