Healthcare Provider Details

I. General information

NPI: 1831439827
Provider Name (Legal Business Name): KRISTIENE DAMPIOS TORRES LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2013
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 MAIN ST.
FAIRFAX VA
22030
US

IV. Provider business mailing address

2025 MALEADY DR
HERNDON VA
20170-4019
US

V. Phone/Fax

Practice location:
  • Phone: 703-273-7705
  • Fax:
Mailing address:
  • Phone: 703-300-6592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306603474
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: