Provider Demographics
NPI:1952909228
Name:THE ANKLE AND FOOT CLINIC OF NORTHERN VIRGINIA, PLLC
Entity Type:Organization
Organization Name:THE ANKLE AND FOOT CLINIC OF NORTHERN VIRGINIA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COLBY
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSSETT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:703-743-5457
Mailing Address - Street 1:7521 VIRGINIA OAKS DR STE 104
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-3831
Mailing Address - Country:US
Mailing Address - Phone:703-743-5457
Mailing Address - Fax:703-454-5778
Practice Address - Street 1:7521 VIRGINIA OAKS DR STE 104
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3831
Practice Address - Country:US
Practice Address - Phone:703-743-5457
Practice Address - Fax:703-454-5778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-09
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty