Provider Demographics
NPI:1558388678
Name:GROHS, KRISTIN AMIRAIAN (MSPT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:AMIRAIAN
Last Name:GROHS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:MARIE
Other - Last Name:AMIRAIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:11240 WAPLES MILL ROAD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030
Mailing Address - Country:US
Mailing Address - Phone:703-385-4707
Mailing Address - Fax:703-691-4933
Practice Address - Street 1:1850 TOWN CENTER PARKWAY
Practice Address - Street 2:SUITE 403
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190
Practice Address - Country:US
Practice Address - Phone:703-736-2806
Practice Address - Fax:703-736-1677
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305006739225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA014144C95Medicare ID - Type Unspecified