Healthcare Provider Details

I. General information

NPI: 1912399395
Provider Name (Legal Business Name): DYNAMIC FOOT AND ANKLE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2015
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9010 LORTON STATION BLVD SUITE 270
LORTON VA
22079-4792
US

IV. Provider business mailing address

9010 LORTON STATION BLVD SUITE 270
LORTON VA
22079-4792
US

V. Phone/Fax

Practice location:
  • Phone: 571-418-8670
  • Fax: 571-418-8671
Mailing address:
  • Phone: 571-418-8670
  • Fax: 571-418-8671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number0103301037
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DANNIELLE VONDERLINDEN
Title or Position: AO
Credential:
Phone: 571-418-8670