Provider Demographics
NPI:1831393891
Name:MUNGO, NINA ANJANETTE (MPT)
Entity type:Individual
Prefix:MRS
First Name:NINA
Middle Name:ANJANETTE
Last Name:MUNGO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 JOSEPHINE CRES
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-3919
Mailing Address - Country:US
Mailing Address - Phone:757-420-2205
Mailing Address - Fax:
Practice Address - Street 1:1008 JOSEPHINE CRES
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-3919
Practice Address - Country:US
Practice Address - Phone:757-420-2205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305005826225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist