Provider Demographics
NPI:1225542012
Name:CHENG, ERWIN
Entity Type:Individual
Prefix:
First Name:ERWIN
Middle Name:
Last Name:CHENG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23393 MINERVA DR
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148-6863
Mailing Address - Country:US
Mailing Address - Phone:703-352-1939
Mailing Address - Fax:703-352-2294
Practice Address - Street 1:23393 MINERVA DR
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20148-6863
Practice Address - Country:US
Practice Address - Phone:703-352-1939
Practice Address - Fax:703-352-2294
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205429225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty