Provider Demographics
NPI:1184640989
Name:SMITH, CHRISTINA (MPT, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MPT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 REINEKERS LN STE GR4
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2871
Mailing Address - Country:US
Mailing Address - Phone:703-299-3111
Mailing Address - Fax:703-299-1556
Practice Address - Street 1:225 REINEKERS LN STE GR4
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2871
Practice Address - Country:US
Practice Address - Phone:703-299-3111
Practice Address - Fax:703-299-1556
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT870591225100000X
VA2305203188225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCF8710006OtherCAREFIRST BLUE CROSS BLUE SHIELD
DC017923P88Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER