Provider Demographics
NPI:1003358169
Name:SON, MINKYEONG (DPT)
Entity Type:Individual
Prefix:
First Name:MINKYEONG
Middle Name:
Last Name:SON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7010 LITTLE RIVER TPKE STE 335
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3249
Mailing Address - Country:US
Mailing Address - Phone:703-827-3488
Mailing Address - Fax:703-827-3499
Practice Address - Street 1:7010 LITTLE RIVER TPKE STE 335
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3249
Practice Address - Country:US
Practice Address - Phone:703-827-3488
Practice Address - Fax:703-827-3499
Is Sole Proprietor?:No
Enumeration Date:2016-11-07
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305211819225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist