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General NPI Number Information
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NPI Number | 1720694219
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Entity Type | Individual
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Provider Name | NICOLE ELIZABETH DIERKES DPT
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Gender | Female
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Dates
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Enumeration Date | 09/20/2020
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Last Update Date | 09/20/2020
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Provider Practice Location Address
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Address Line | 225 REINEKERS LN STE GR4
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City | ALEXANDRIA
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State | VA
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Zip | 22314-2871
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Country | US
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Telephone | 703-299-3111
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Fax |
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Provider Business Mailing Address
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Address Line | 4205 MINTON DR
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City | FAIRFAX
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State | VA
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Zip | 22032-1134
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Country | US
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Telephone | 703-220-7672
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305213920
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License Number State | VA
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