Provider Demographics
NPI:1447338918
Name:EARLE, NANCY F (MSPT)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:F
Last Name:EARLE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 BELLAMY AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-3402
Mailing Address - Country:US
Mailing Address - Phone:703-569-3264
Mailing Address - Fax:
Practice Address - Street 1:6801 BELLAMY AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-3402
Practice Address - Country:US
Practice Address - Phone:703-569-3264
Practice Address - Fax:703-569-3264
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205082225100000X
HI1381225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI55758001Medicaid
HI0000249623OtherHMSA
HI57586Medicare ID - Type Unspecified