Provider Demographics
NPI:1396247466
Name:ZOOK, LETHA B (PT)
Entity type:Individual
Prefix:
First Name:LETHA
Middle Name:B
Last Name:ZOOK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 S JOYCE ST APT 813
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-1880
Mailing Address - Country:US
Mailing Address - Phone:304-281-7576
Mailing Address - Fax:
Practice Address - Street 1:1778 FOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3390
Practice Address - Country:US
Practice Address - Phone:703-956-8930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305211602225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist