Provider Demographics
NPI:1427822774
Name:CHRISTIAN, CASSIDY JOLAINE (PT, DPT)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:JOLAINE
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 S BARTON CT APT 401
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-2826
Mailing Address - Country:US
Mailing Address - Phone:724-953-9621
Mailing Address - Fax:
Practice Address - Street 1:8348 TRAFORD LN STE 100
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1650
Practice Address - Country:US
Practice Address - Phone:703-569-7335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305216171225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist