Provider Demographics
NPI:1992855167
Name:ASHDALE CHIROPRACTIC & PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ASHDALE CHIROPRACTIC & PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:703-583-1222
Mailing Address - Street 1:2950 DALE BLVD
Mailing Address - Street 2:
Mailing Address - City:DALE CITY
Mailing Address - State:VA
Mailing Address - Zip Code:22193-1120
Mailing Address - Country:US
Mailing Address - Phone:703-583-1222
Mailing Address - Fax:703-583-1499
Practice Address - Street 1:2950 DALE BLVD
Practice Address - Street 2:
Practice Address - City:DALE CITY
Practice Address - State:VA
Practice Address - Zip Code:22193-1120
Practice Address - Country:US
Practice Address - Phone:703-583-1222
Practice Address - Fax:703-583-1499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119000443225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008733A53Medicare ID - Type Unspecified