Individual
POPO PI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3305 WYNDHAM CIR APT 254, ALEXANDRIA, VA 22302-4305
(541) 206-9666
Mailing address
3305 WYNDHAM CIR APT 254, ALEXANDRIA, VA 22302-4305
(541) 206-9666
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306605125
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2306605125
VIRGINIA PHYSICAL THERAPIST ASSISTANT LICENSE NUMBER
VA
Enumeration date
02/16/2023
Last updated
02/16/2023
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