Healthcare Provider Details

I. General information

NPI: 1821912221
Provider Name (Legal Business Name): MIRANDA LYNN STODDARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17451 FRALEY BLVD
DUMFRIES VA
22026-2244
US

IV. Provider business mailing address

16056 JOHN QUICK RD
QUANTICO VA
22134-1956
US

V. Phone/Fax

Practice location:
  • Phone: 703-221-3913
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305217905
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: