Provider Demographics
NPI:1962709808
Name:WITT, TALAYEH WILLIAMS (PTA)
Entity type:Individual
Prefix:MRS
First Name:TALAYEH
Middle Name:WILLIAMS
Last Name:WITT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 TURNSTONE CT
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-6019
Mailing Address - Country:US
Mailing Address - Phone:540-752-2794
Mailing Address - Fax:
Practice Address - Street 1:63 TURNSTONE CT
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-6019
Practice Address - Country:US
Practice Address - Phone:540-752-2794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306602060225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant