Individual
BLANCA CEREZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
13854 SMOKETOWN RD, WOODBRIDGE, VA 22192-4210
(703) 670-9935
(703) 670-9939
Mailing address
5252 LYNGATE CT, BURKE, VA 22015-1672
(703) 239-2300
(703) 239-2301
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
18472
MD
225100000X
Physical Therapist
Primary
2305205150
VA
225100000X
Physical Therapist
2874
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2307001059
DIRECT ACCESS CERTIFICATION
VA
01
—
K949 - 0010
CAREFIRST
VA
Enumeration date
09/24/2008
Last updated
09/23/2015
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