Provider Demographics
NPI:1710768684
Name:THOMAS, SANDRA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:THOMAS
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 1:4196 MERCHANT PLZ # 605
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5085
Mailing Address - Country:US
Mailing Address - Phone:617-792-5329
Mailing Address - Fax:
Practice Address - Street 1:1372 OLD BRIDGE RD STE 102
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2755
Practice Address - Country:US
Practice Address - Phone:617-792-5329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019008553225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist