Provider Demographics
NPI:1528314044
Name:WOOTEN, LIANA CHRISTINE (DPT)
Entity type:Individual
Prefix:
First Name:LIANA
Middle Name:CHRISTINE
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8346 TRAFORD LANE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152
Mailing Address - Country:US
Mailing Address - Phone:703-913-5705
Mailing Address - Fax:703-913-5706
Practice Address - Street 1:8346 TRAFORD LANE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152
Practice Address - Country:US
Practice Address - Phone:703-913-5705
Practice Address - Fax:703-913-5706
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207471225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist