Provider Demographics
NPI:1275187130
Name:CLANAHAN, CHERYL SUZANNE (PTA)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:SUZANNE
Last Name:CLANAHAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N GLEBE RD STE 310
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-3761
Mailing Address - Country:US
Mailing Address - Phone:703-527-1700
Mailing Address - Fax:
Practice Address - Street 1:200 N GLEBE RD STE 310
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-3761
Practice Address - Country:US
Practice Address - Phone:703-527-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306605409225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant