Provider Demographics
NPI:1881045730
Name:WEIR, LYNNE (PT)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:
Last Name:WEIR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 W TIMBER BRANCH PKWY
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-4229
Mailing Address - Country:US
Mailing Address - Phone:703-509-3422
Mailing Address - Fax:
Practice Address - Street 1:430 W TIMBER BRANCH PKWY
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-4229
Practice Address - Country:US
Practice Address - Phone:703-509-3422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305000990225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist