Provider Demographics
NPI:1952961989
Name:PHYSICIANS PREMIERE WEIGHT & WELLNESS CENTER, P.L.L.C.
Entity Type:Organization
Organization Name:PHYSICIANS PREMIERE WEIGHT & WELLNESS CENTER, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:
Authorized Official - Last Name:TISSANDIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-406-6645
Mailing Address - Street 1:23289 MEADOWVALE GLEN CT
Mailing Address - Street 2:
Mailing Address - City:DULLES
Mailing Address - State:VA
Mailing Address - Zip Code:20166-2151
Mailing Address - Country:US
Mailing Address - Phone:703-783-5673
Mailing Address - Fax:703-297-8100
Practice Address - Street 1:25055 RIDING PLZ STE 230
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20152-5920
Practice Address - Country:US
Practice Address - Phone:703-783-5673
Practice Address - Fax:703-297-8100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty