Provider Demographics
NPI:1548413388
Name:KENNEDY, CHRISTINA MARIE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:MARIE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10331 BUSHMAN DR
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-2828
Mailing Address - Country:US
Mailing Address - Phone:703-231-3546
Mailing Address - Fax:
Practice Address - Street 1:3299 WOODBURN RD STE 310
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-7300
Practice Address - Country:US
Practice Address - Phone:703-849-8142
Practice Address - Fax:703-849-0735
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205709225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist