Provider Demographics
NPI:1902548662
Name:AN, SUK JA (LICMASSAGE THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:SUK JA
Middle Name:
Last Name:AN
Suffix:
Gender:F
Credentials:LICMASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10350 LURIA COMMONS CT # 3G
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-2824
Mailing Address - Country:US
Mailing Address - Phone:703-989-1933
Mailing Address - Fax:
Practice Address - Street 1:8109 HINSON FARM RD STE 515
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3427
Practice Address - Country:US
Practice Address - Phone:703-765-7275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019018547225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1935175OtherMASSAGE THERAPIST