Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2305002884 | VA |
N | 2251H1200X | Hand | 2305002884 | VA |
NPI | 1861457319 |
---|---|
Provider Name | Mrs. Allyce Ann Staffen |
First Address | Leesburg, VA 20176-1707 |
Second Address | Leesburg, VA 20176 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 19/02/2019 |