Provider Demographics
NPI:1548211840
Name:FAINSAN, JOHN J (MSPT, CSCS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:FAINSAN
Suffix:
Gender:M
Credentials:MSPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 SUNRISE VALLEY DR STE 100
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-5309
Mailing Address - Country:US
Mailing Address - Phone:703-709-1116
Mailing Address - Fax:703-709-5134
Practice Address - Street 1:11800 SUNRISE VALLEY DR
Practice Address - Street 2:100
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191
Practice Address - Country:US
Practice Address - Phone:703-709-1116
Practice Address - Fax:703-709-5134
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9576174400000X
VA2305207532225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9576OtherPHYSICAL THERAPY