Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 9722 | CO |
Y | 2251P0200X | Physical Therapist - Pediatrics | 2305207613 | VA |
NPI | 1033382148 |
---|---|
Provider Name | Mrs. Nicole Leonie Fainsan |
First Address | Reston, VA 20190-4140 |
Second Address | Herndon, VA 20170-4861 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2008 |
Last Update Date | 06/03/2013 |