Healthcare Provider Details

I. General information

NPI: 1457791196
Provider Name (Legal Business Name): LUCIA Z. MANOUKIAN CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 08/26/2026
Certification Date:
Deactivation Date: 07/23/2018
Reactivation Date: 08/26/2026

III. Provider practice location address

44121 HARRY BYRD HWY SUITE 115
ASHBURN VA
20147-5667
US

IV. Provider business mailing address

44144 ALLDERWOOD TER
ASHBURN VA
20147-2820
US

V. Phone/Fax

Practice location:
  • Phone: 703-909-6618
  • Fax:
Mailing address:
  • Phone: 703-909-6618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019009486
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: