Provider Demographics
NPI:1861239055
Name:WASHINGTON, SAMANTHA YVONNE (LMT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:YVONNE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 SAINT JAMES RD
Mailing Address - Street 2:
Mailing Address - City:ACCOKEEK
Mailing Address - State:MD
Mailing Address - Zip Code:20607-3132
Mailing Address - Country:US
Mailing Address - Phone:202-766-6448
Mailing Address - Fax:
Practice Address - Street 1:1727 KING ST FL 3
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2700
Practice Address - Country:US
Practice Address - Phone:301-892-1543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-13
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019019159225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist