Provider Demographics
NPI:1346135019
Name:DOMINGUEZ ALVAREZ, DANAE MARINELLY (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MISS
First Name:DANAE
Middle Name:MARINELLY
Last Name:DOMINGUEZ ALVAREZ
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15742 WIDEWATER DR
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22025-1212
Mailing Address - Country:US
Mailing Address - Phone:571-296-8518
Mailing Address - Fax:
Practice Address - Street 1:14801 MURDOCK ST
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1037
Practice Address - Country:US
Practice Address - Phone:571-551-8304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019017947225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist