Individual
GRACE SOPHIA PAKKIANATHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
40617 WOODSIDE PL, LEESBURG, VA 20175-8837
(301) 404-8697
Mailing address
40617 WOODSIDE PL, LEESBURG, VA 20175-8837
(301) 404-8697
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305005578
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2305005578
PT LICENSE
VA
Enumeration date
01/06/2020
Last updated
01/06/2020
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