Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter | ||
Y | 2251X0800X | Physical Therapist - Orthopedic | 2305204989 | VA |
NPI | 1780898023 |
---|---|
Provider Name | Andre B Heletsi |
First Address | Fairfax, VA 22030-6269 |
Second Address | Ashburn, VA 20147-6300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 09/06/2014 |