Individual provider Active NPI

Nolawit Haile, MPT

  • Physical Therapist
  • Alexandria, VA
National Provider Identifier
1417182833
Registry record updated Apr 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2305205919 Issued in VA
Practice address
4605 Duke St
Alexandria, VA 22304-2505
Phone
(703) 751-1052
Fax
(703) 751-1053
NPI assigned
May 29, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2305205919 VA Primary

Addresses

Primary practice location

4605 Duke St
Alexandria, VA 22304-2505

Mailing address

501 Fairmount Ave
Suite 302
Towson, MD 21286-5457
Phone (410) 927-8768

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20090709000489 DC Practitioner - Physical Therapist in Private Practice 1951453737 Reassigns benefits to 1 organization
I20151214002461 VA Practitioner - Physical Therapist in Private Practice 1951453737 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Sportscare & Rehab, LLC Physical Therapist CurrentSince May 15, 2017 Accepting new patients
Professional Sportscare & Rehab, LLC Physical Therapist Past Accepting new patients
Professional Sportscare & Rehab, LLC Physical Therapist Past Accepting new patients

Locations

4605 Duke St
Alexandria, VA 22304
Phone (703) 751-1052

1600 Wilson Blvd
Ste 102
Arlington, VA 22209
Phone (301) 464-4500

11662 Sudley Manor Dr
#50B
Manassas, VA 20109
Phone (571) 321-5720

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1243555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493337600000",
    "number": "1417182833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 FAIRMOUNT AVE",
            "address_2": "SUITE 302",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212865457",
            "telephone_number": "410-927-8768",
            "fax_number": "410-648-4878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4605 DUKE ST",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223042505",
            "telephone_number": "703-751-1052",
            "fax_number": "703-751-1053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAILE",
        "first_name": "NOLAWIT",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-29",
        "last_updated": "2017-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305205919",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alexandria, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.