Provider Demographics
NPI:1558318352
Name:LONG, ERIN KATHREN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:KATHREN
Last Name:LONG
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 1:42020 VILLAGE CENTER PLZ
Mailing Address - Street 2:SUITE 120-163
Mailing Address - City:STONE RIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-3034
Mailing Address - Country:US
Mailing Address - Phone:703-400-0784
Mailing Address - Fax:703-722-0703
Practice Address - Street 1:42020 VILLAGE CENTER PLZ
Practice Address - Street 2:SUITE 120-163
Practice Address - City:STONE RIDGE
Practice Address - State:VA
Practice Address - Zip Code:20105-3034
Practice Address - Country:US
Practice Address - Phone:703-400-0784
Practice Address - Fax:703-722-0703
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2012-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204552225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist