Provider Demographics
NPI:1417799628
Name:ELASHA, MARYA RAHAMTALLA (PT, DPT)
Entity type:Individual
Prefix:MISS
First Name:MARYA
Middle Name:RAHAMTALLA
Last Name:ELASHA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:BRACEY
Mailing Address - State:VA
Mailing Address - Zip Code:23919-0039
Mailing Address - Country:US
Mailing Address - Phone:804-955-9506
Mailing Address - Fax:
Practice Address - Street 1:44927 GEORGE WASHINGTON BLVD STE 210
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-4292
Practice Address - Country:US
Practice Address - Phone:571-291-9936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305216543225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty