Individual
POONCHIDA SUKRUTTANAVASIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5975 TERRAPIN PL UNIT 102, ALEXANDRIA, VA 22310-5459
(571) 365-1579
Mailing address
5975 TERRAPIN PL UNIT 102, ALEXANDRIA, VA 22310-5459
(571) 365-1579
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
0019014665
VA
Other
Enumeration date
09/08/2021
Last updated
09/08/2021
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