Provider Demographics
NPI:1326367731
Name:SOULE', RENAE JOAN (PT)
Entity Type:Individual
Prefix:
First Name:RENAE
Middle Name:JOAN
Last Name:SOULE'
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:RENAE
Other - Middle Name:
Other - Last Name:MONIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1769
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20118-1769
Mailing Address - Country:US
Mailing Address - Phone:540-687-8181
Mailing Address - Fax:540-687-8256
Practice Address - Street 1:8986 LORTON STATION BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-4753
Practice Address - Country:US
Practice Address - Phone:703-546-0013
Practice Address - Fax:703-546-0014
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204238225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist