Provider Demographics
NPI:1073273173
Name:ENGEBRITSON, AMANDA KATHERINE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:KATHERINE
Last Name:ENGEBRITSON
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 1:5704 26TH ST N
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-1410
Mailing Address - Country:US
Mailing Address - Phone:571-241-9348
Mailing Address - Fax:
Practice Address - Street 1:8320 OLD COURTHOUSE RD STE 410
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3848
Practice Address - Country:US
Practice Address - Phone:703-734-2889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-30
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214798225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist