Provider Demographics
NPI:1043344963
Name:INFANTE, ROBERTO (PT)
Entity type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:
Last Name:INFANTE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14605 POTOMAC BRANCH DR
Mailing Address - Street 2:STE 300
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3337
Mailing Address - Country:US
Mailing Address - Phone:703-490-1112
Mailing Address - Fax:703-878-8735
Practice Address - Street 1:4229 LAFAYETTE CENTER DR
Practice Address - Street 2:1250
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1209
Practice Address - Country:US
Practice Address - Phone:703-263-2020
Practice Address - Fax:703-263-2015
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2305001625225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA496675Medicare ID - Type Unspecified