Provider Demographics
NPI:1336946912
Name:MARQUEZ, KISHA LEVINITA (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:KISHA
Middle Name:LEVINITA
Last Name:MARQUEZ
Suffix:
Gender:
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 1:8626 AMBROSE CT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-3744
Mailing Address - Country:US
Mailing Address - Phone:540-841-4679
Mailing Address - Fax:
Practice Address - Street 1:24570 DULLES LANDING DR UNIT 160
Practice Address - Street 2:
Practice Address - City:DULLES
Practice Address - State:VA
Practice Address - Zip Code:20166-2622
Practice Address - Country:US
Practice Address - Phone:540-841-4679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019018016225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist