Provider Demographics
NPI:1669826269
Name:PINE, RICHARD (DPT)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:PINE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 FAIRFAX DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1500
Mailing Address - Country:US
Mailing Address - Phone:703-841-0391
Mailing Address - Fax:703-841-0397
Practice Address - Street 1:4601 FAIRFAX DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1500
Practice Address - Country:US
Practice Address - Phone:703-841-0391
Practice Address - Fax:703-841-0397
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305210040225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist