Healthcare Provider Details

I. General information

NPI: 1164574125
Provider Name (Legal Business Name): CLARE W KALINA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 11/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3289 WOODBURN ROAD STE 130
ANNANDALE VA
22003
US

IV. Provider business mailing address

3289 WOODBURN ROAD STE 130
ANNANDALE VA
22003
US

V. Phone/Fax

Practice location:
  • Phone: 571-389-7150
  • Fax: 703-992-7584
Mailing address:
  • Phone: 571-389-7150
  • Fax: 703-992-7584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305002122
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: