Provider Demographics
NPI:1558913749
Name:AHNER, KRISTINA WALES (LMT)
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:WALES
Last Name:AHNER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:KRISSY
Other - Middle Name:
Other - Last Name:AHNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:2240 CASTLE ROCK SQ APT 1B
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-2226
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:464 HERNDON PKWY STE 116
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-5200
Practice Address - Country:US
Practice Address - Phone:540-226-8009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019013699225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist