Basic Information
| Provider Information | |||||||||
| NPI: | 1720027196 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IRWIN | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | DAHL | ||||||||
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| Credential: | MS PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1115 BOULDERS PKWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | NORTH CHESTERFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232254067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045605595 | ||||||||
| FaxNumber: | 8045609029 | ||||||||
| Practice Location | |||||||||
| Address1: | 7650 E PARHAM RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232944373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042826338 | ||||||||
| FaxNumber: | 8042853237 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2006 | ||||||||
| LastUpdateDate: | 10/30/2013 | ||||||||
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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 | 2305004909 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 008908761 | 05 | VA | MEDICAID | 192301 | 01 | VA | ANTHEM PT | OTHER | 98999 | 01 | VA | OPTIMA HEALTH | OTHER | 540885859 | 01 | VA | MULTIPLAN | OTHER | 2485613 | 01 | VA | AETNA HMO | OTHER | 540885859 | 01 | VA | C&O EMPLOYEE'S HEALTHCARE | OTHER | 540885859 | 01 | VA | CIGNA REHAB | OTHER | 540885859 | 01 | VA | PRIVATE HEALTHCARE SYSTEM | OTHER | 540885859 | 01 | VA | FOCUS | OTHER | 540885859 | 01 | VA | FIRST HEALTH/CCN | OTHER | 540885859 | 01 | VA | VIRGINIA HEALTH NETWORK | OTHER | 258462 | 01 | VA | SOUTHERN HEALTH | OTHER | 540885859 | 01 | VA | COMPMANAGEMENT | OTHER | 540885859 | 01 | VA | CORVEL | OTHER |