Provider Demographics
NPI:1588680300
Name:ANDOLINO, AILEEN C (MPT, ATC)
Entity type:Individual
Prefix:MRS
First Name:AILEEN
Middle Name:C
Last Name:ANDOLINO
Suffix:
Gender:F
Credentials:MPT, ATC
Other - Prefix:
Other - First Name:AILEEN
Other - Middle Name:E
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT, ATC
Mailing Address - Street 1:9447B LORTON MARKET ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-1963
Mailing Address - Country:US
Mailing Address - Phone:703-372-5716
Mailing Address - Fax:703-372-5718
Practice Address - Street 1:9447B LORTON MARKET ST
Practice Address - Street 2:SUITE 250
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-1963
Practice Address - Country:US
Practice Address - Phone:703-372-5716
Practice Address - Fax:703-372-5718
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204243225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCF8710008OtherCAREFIRST BLUE CROSS BLUE SHIELD
DCF8710008OtherCAREFIRST BLUE CROSS BLUE SHIELD