Healthcare Provider Details

I. General information

NPI: 1033350079
Provider Name (Legal Business Name): KRISTIN LINN PALMER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2009
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11200 WAPLES MILL RD STE 100
FAIRFAX VA
22030-7475
US

IV. Provider business mailing address

11200 WAPLES MILL RD STE 100
FAIRFAX VA
22030-7475
US

V. Phone/Fax

Practice location:
  • Phone: 703-237-2219
  • Fax:
Mailing address:
  • Phone: 703-237-2219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number33783
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2305212464
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: