Individual provider Active NPI

Abdul Hasan, PT

  • Physical Therapist
  • Fairfax, VA
National Provider Identifier
1598358335
Registry record updated Feb 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2305214187 Issued in VA
Practice address
10517 Braddock Rd Ste D
Fairfax, VA 22032-2275
Phone
(571) 351-5618
Fax
(571) 351-5619
NPI assigned
Feb 12, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2021

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 2305214187 VA Primary

Addresses

Primary practice location

10517 Braddock Rd Ste D
Fairfax, VA 22032-2275

Mailing address

PO Box 1769
Middleburg, VA 20118-1769
Phone (571) 351-5618

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210309001020 DC Practitioner - Physical Therapist in Private Practice 7719393248 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2305214187VAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group, LLC CurrentSince Aug 23, 2024 Accepting new patients
Privia Medical Group, LLC CurrentSince Aug 23, 2024 Accepting new patients
Resurgent Sports Rehab LLC Physical Therapist CurrentSince Jul 27, 2021 Accepting new patients
The Jackson Clinics LLC Physical Therapist PastSince Feb 24, 2021 Accepting new patients

Locations

9470 Annapolis Rd
Ste 309
Lanham, MD 20706
Phone (202) 832-1800

950 N Glebe Rd
Ste 700
Arlington, VA 22203
Phone (484) 228-1065

8500 Executive Park Ave
Ste 100
Fairfax, VA 22031
Phone (703) 346-6517

Interoperability endpoints

  • Direct secure messaging: aziz.hasan.1@8042.direct.athenahealth.com

Organizations & group practices 4

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": "1613088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614297600000",
    "number": "1598358335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1769",
            "city": "MIDDLEBURG",
            "state": "VA",
            "postal_code": "201181769",
            "telephone_number": "571-351-5618",
            "fax_number": "571-351-5619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10517 BRADDOCK RD STE D",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220322275",
            "telephone_number": "571-351-5618",
            "fax_number": "571-351-5619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HASAN",
        "first_name": "ABDUL",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-02-12",
        "last_updated": "2021-02-26",
        "certification_date": "2021-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305214187",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2021; 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.