Healthcare Provider Details

I. General information

NPI: 1043180805
Provider Name (Legal Business Name): NICOLE MARIE ZALESAK MMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2025
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5185 MACARTHUR BLVD NW STE 210
WASHINGTON DC
20016-3345
US

IV. Provider business mailing address

2701 8TH ST S APT 301A
ARLINGTON VA
22204-2261
US

V. Phone/Fax

Practice location:
  • Phone: 202-306-5926
  • Fax:
Mailing address:
  • Phone: 202-306-5926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019018126
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: