Provider Demographics
NPI:1730390402
Name:WASHINGTON, TERRACE (LMT, CMT)
Entity type:Individual
Prefix:
First Name:TERRACE
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:LMT, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6404 CHATHAM PARK DR
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-5640
Mailing Address - Country:US
Mailing Address - Phone:954-290-9695
Mailing Address - Fax:
Practice Address - Street 1:900 PRINCE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-3009
Practice Address - Country:US
Practice Address - Phone:703-683-7771
Practice Address - Fax:703-683-8777
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019009438225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist