Provider Demographics
NPI:1710345525
Name:VASQUEZ, PAOLA ANDREA (DPT)
Entity Type:Individual
Prefix:MS
First Name:PAOLA
Middle Name:ANDREA
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:PAOLA
Other - Middle Name:ANDREA
Other - Last Name:GARCIA VEIZAGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3620 JOSEPH SIEWICK DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1756
Mailing Address - Country:US
Mailing Address - Phone:703-391-2450
Mailing Address - Fax:703-391-3142
Practice Address - Street 1:3620 JOSEPH SIEWICK DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1756
Practice Address - Country:US
Practice Address - Phone:703-391-2450
Practice Address - Fax:703-391-3142
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-08
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305210030225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist