Provider Demographics
NPI:1417181512
Name:MURPHY, KRISTINA R (PT, MPT)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:R
Last Name:MURPHY
Suffix:
Gender:F
Credentials:PT, MPT
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:L
Other - Last Name:RUTHERFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12825 MINNIEVILLE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:LAKE RIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-3602
Mailing Address - Country:US
Mailing Address - Phone:703-647-3130
Mailing Address - Fax:
Practice Address - Street 1:12825 MINNIEVILLE RD STE 201
Practice Address - Street 2:
Practice Address - City:LAKE RIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-3602
Practice Address - Country:US
Practice Address - Phone:703-647-3130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305006707225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist