Provider Demographics
NPI:1568132009
Name:SANDIDGE, NORRITA L (LMT)
Entity Type:Individual
Prefix:
First Name:NORRITA
Middle Name:L
Last Name:SANDIDGE
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 1:12125 PANTHERS RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-3905
Mailing Address - Country:US
Mailing Address - Phone:301-461-2439
Mailing Address - Fax:
Practice Address - Street 1:801 N QUINCY ST STE 130
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1708
Practice Address - Country:US
Practice Address - Phone:703-527-5492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019017991225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist