Provider Demographics
NPI:1639958325
Name:PARK, SARAH CATHERINE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:CATHERINE
Last Name:PARK
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 1:9433 SHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-1620
Mailing Address - Country:US
Mailing Address - Phone:571-315-1515
Mailing Address - Fax:
Practice Address - Street 1:400 HERNDON PKWY STE 125
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-5299
Practice Address - Country:US
Practice Address - Phone:703-705-4665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305216038225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist