Provider Demographics
NPI:1255743902
Name:ULSTAD, PATIENCE (CMT)
Entity type:Individual
Prefix:
First Name:PATIENCE
Middle Name:
Last Name:ULSTAD
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5616 23RD ST N
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3110
Mailing Address - Country:US
Mailing Address - Phone:619-316-9297
Mailing Address - Fax:
Practice Address - Street 1:712 W BROAD ST STE 8
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3222
Practice Address - Country:US
Practice Address - Phone:619-241-9404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019017591225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist