Provider Demographics
NPI:1043320799
Name:MUZINA, NICHOLE
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:MUZINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20600 CORNSTALK TER APT 302
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-3954
Mailing Address - Country:US
Mailing Address - Phone:703-619-1542
Mailing Address - Fax:
Practice Address - Street 1:19441 GOLF VISTA PLZ
Practice Address - Street 2:SUITE 230
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-8269
Practice Address - Country:US
Practice Address - Phone:703-724-7474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2305202915OtherLICENSE#