Provider Demographics
NPI:1083068399
Name:PULLEN, LINDA (ATC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:PULLEN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 UNIVERSITY DR
Mailing Address - Street 2:MS 3A5
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4422
Mailing Address - Country:US
Mailing Address - Phone:703-993-3280
Mailing Address - Fax:703-993-3360
Practice Address - Street 1:4400 UNIVERSITY DR
Practice Address - Street 2:MS 3A5
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4422
Practice Address - Country:US
Practice Address - Phone:703-993-3280
Practice Address - Fax:703-993-3360
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-22
Last Update Date:2016-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260005762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer