Healthcare Provider Details

I. General information

NPI: 1558318352
Provider Name (Legal Business Name): ERIN KATHREN LONG P.T., D.P.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42020 VILLAGE CENTER PLZ SUITE 120-163
STONE RIDGE VA
20105-3034
US

IV. Provider business mailing address

42020 VILLAGE CENTER PLZ SUITE 120-163
STONE RIDGE VA
20105-3034
US

V. Phone/Fax

Practice location:
  • Phone: 703-400-0784
  • Fax: 703-722-0703
Mailing address:
  • Phone: 703-400-0784
  • Fax: 703-722-0703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305204552
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: