Provider Demographics
NPI:1861909061
Name:TEKLE, ELLENI ESTIFANOS (DPT)
Entity type:Individual
Prefix:
First Name:ELLENI
Middle Name:ESTIFANOS
Last Name:TEKLE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7363 STREAM WAY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-3638
Mailing Address - Country:US
Mailing Address - Phone:703-347-2535
Mailing Address - Fax:
Practice Address - Street 1:7223 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-3411
Practice Address - Country:US
Practice Address - Phone:703-935-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305211629225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC69606099OtherVIRGINIA DRIVER'S LICENSE