Provider Demographics
NPI:1134841430
Name:MARTIN, MANOLYA (PT, DPT)
Entity type:Individual
Prefix:
First Name:MANOLYA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4084 UNIVERSITY DR STE 103
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6803
Mailing Address - Country:US
Mailing Address - Phone:703-896-9999
Mailing Address - Fax:703-896-9998
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:703-896-9998
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305215360225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist