Healthcare Provider Details

I. General information

NPI: 1366747891
Provider Name (Legal Business Name): SHERYL KATHLEEN GONCALVES DPT, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 12/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11240 WAPLES MILL RD SUITE 101
FAIRFAX VA
22030-6078
US

IV. Provider business mailing address

8503 BROMLEY CT
ANNANDALE VA
22003-4533
US

V. Phone/Fax

Practice location:
  • Phone: 703-237-2219
  • Fax:
Mailing address:
  • Phone: 571-239-5830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2305205015
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: