Healthcare Provider Details

I. General information

NPI: 1679419154
Provider Name (Legal Business Name): ANNE M. BLACKSTONE PT, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44075 PIPELINE PLZ
ASHBURN VA
20147-5889
US

IV. Provider business mailing address

19068 QUIVER RIDGE DR
LEESBURG VA
20176-8448
US

V. Phone/Fax

Practice location:
  • Phone: 703-593-6090
  • Fax:
Mailing address:
  • Phone: 703-593-6090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number2305203305
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number2305203305
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: