Provider Demographics
NPI:1063070167
Name:PRADA, VIRGINIA I
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:I
Last Name:PRADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 12TH ST S APT 1839
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-4280
Mailing Address - Country:US
Mailing Address - Phone:571-305-0280
Mailing Address - Fax:
Practice Address - Street 1:520 12TH ST S APT 1839
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202-4280
Practice Address - Country:US
Practice Address - Phone:571-305-0280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019013377225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist