Healthcare Provider Details

I. General information

NPI: 1396801171
Provider Name (Legal Business Name): GAVIN CRIBB DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 06/01/2020
Certification Date: 06/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8180 GREENSBORO DR STE 300-A
MC LEAN VA
22102-3888
US

IV. Provider business mailing address

11240 WAPLES MILL RD STE 403
FAIRFAX VA
22030-6078
US

V. Phone/Fax

Practice location:
  • Phone: 703-810-5224
  • Fax: 703-810-5475
Mailing address:
  • Phone: 703-383-6454
  • Fax: 703-810-5494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305204901
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: