Basic Information
| Provider Information | |||||||||
| NPI: | 1184640989 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | CHRISTINA | ||||||||
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| Credential: | MPT, ATC, CSCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 REINEKERS LN STE GR4 | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223142871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032993111 | ||||||||
| FaxNumber: | 7032991556 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 REINEKERS LN STE GR4 | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223142871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032993111 | ||||||||
| FaxNumber: | 7032991556 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 10/24/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT870591 | DC | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 2305203188 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | F8710006 | 01 | DC | CAREFIRST BLUE CROSS BLUE SHIELD | OTHER |