Healthcare Provider Details

I. General information

NPI: 1164747283
Provider Name (Legal Business Name): ANDREA RIBANDO BRUNK DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3709 3RD ST S
ARLINGTON VA
22204-1638
US

IV. Provider business mailing address

3709 3RD ST S
ARLINGTON VA
22204-1638
US

V. Phone/Fax

Practice location:
  • Phone: 617-733-8590
  • Fax:
Mailing address:
  • Phone: 617-733-8590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT870549
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2305204419
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: