Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2305211429 | VA |
N | 2251X0800X | Physical Therapist - Orthopedic | 2305211429 | VA |
NPI | 1013432863 |
---|---|
Provider Name | Dr. Jessica Ruth Sorano |
First Address | Lorton, VA 22079-2959 |
Second Address | Annandale, VA 22003-7300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2017 |
Last Update Date | 12/08/2017 |