MEDICARE: KRISTYN ANN ARCHBALD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	2305209930	VA

General Provider Information

NPI Number	:	1730865171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTYN ANN ARCHBALD

Provider Business Mailing Address
First Line	:	111 MIDFIELD RD
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-3445
Country	:	US
Telephone Number	:	203-927-9036
Fax Number	:

Provider Business Practice Location Address
First Line	:	11210 ROBIOUS RD
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-3700
Country	:	US
Telephone Number	:	203-927-9036
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2023
Last Update Date	:	06/22/2023

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