Provider Demographics
NPI:1992723670
Name:REED, CRISTIN RAYE (PT DPT)
Entity type:Individual
Prefix:
First Name:CRISTIN
Middle Name:RAYE
Last Name:REED
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:CRISTIN
Other - Middle Name:RAYE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11240 WAPLES MILL RD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030
Mailing Address - Country:US
Mailing Address - Phone:703-385-4707
Mailing Address - Fax:703-691-4933
Practice Address - Street 1:1635 N GEORGE MASON DR
Practice Address - Street 2:SUITE 110
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3601
Practice Address - Country:US
Practice Address - Phone:703-810-5216
Practice Address - Fax:703-810-5494
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204406225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA018349C95Medicare ID - Type Unspecified