Provider Demographics
NPI:1629471149
Name:NUNEZ, SASHA (DPT)
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14070 BETSY ROSS LN
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-3511
Mailing Address - Country:US
Mailing Address - Phone:571-556-8062
Mailing Address - Fax:
Practice Address - Street 1:4084 UNIVERSITY DR STE 103
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6803
Practice Address - Country:US
Practice Address - Phone:703-896-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-29
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305212846225100000X
FLPT29461225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist