Individual
SOCHEATHDARA SAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4040 FAIRFAX DR STE 120, ARLINGTON, VA 22203-1613
(571) 777-0918
Mailing address
3544 GALLOWS RD, ANNANDALE, VA 22003-1450
(301) 979-2951
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306606194
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/11/2022
Last updated
12/27/2023
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