Provider Demographics
NPI:1083486153
Name:THOMPSON, PRISCILLA CALVERT (LMT)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:CALVERT
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43188 SPINKS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-5626
Mailing Address - Country:US
Mailing Address - Phone:571-212-2982
Mailing Address - Fax:
Practice Address - Street 1:485 CARLISLE DR STE A
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-5602
Practice Address - Country:US
Practice Address - Phone:571-323-1088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019004786225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist