Healthcare Provider Details

I. General information

NPI: 1588529861
Provider Name (Legal Business Name): LIJUAN ZHANG LMT
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11741 LEDURA CT APT 105
RESTON VA
20191-2355
US

IV. Provider business mailing address

11741 LEDURA CT APT 105
RESTON VA
20191-2355
US

V. Phone/Fax

Practice location:
  • Phone: 703-220-7368
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019020372
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: