Provider Demographics
NPI:1649583717
Name:GHIETH, NADIA M (PT)
Entity Type:Individual
Prefix:
First Name:NADIA
Middle Name:M
Last Name:GHIETH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8644 SUDLEY RD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4417
Mailing Address - Country:US
Mailing Address - Phone:571-292-9910
Mailing Address - Fax:
Practice Address - Street 1:8644 SUDLEY RD
Practice Address - Street 2:SUITE 308
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4417
Practice Address - Country:US
Practice Address - Phone:571-292-9910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205327225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist