Provider Demographics
NPI:1063811792
Name:MOSHER, KRISTEN
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:MOSHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6551 LOISDALE CT
Mailing Address - Street 2:SUITE 155
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-1828
Mailing Address - Country:US
Mailing Address - Phone:703-822-0039
Mailing Address - Fax:703-822-0211
Practice Address - Street 1:6551 LOISDALE CT
Practice Address - Street 2:SUITE 155
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-1828
Practice Address - Country:US
Practice Address - Phone:703-822-0039
Practice Address - Fax:703-822-0211
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208835225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist