Provider Demographics
NPI:1013495498
Name:ANGLE, KRYSIA MARIE
Entity type:Individual
Prefix:
First Name:KRYSIA
Middle Name:MARIE
Last Name:ANGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRYSIA
Other - Middle Name:MARIE
Other - Last Name:BOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 ELDEN ST STE 242
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4845
Mailing Address - Country:US
Mailing Address - Phone:703-689-3737
Mailing Address - Fax:703-689-3889
Practice Address - Street 1:150 ELDEN ST STE 242
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4845
Practice Address - Country:US
Practice Address - Phone:703-689-3737
Practice Address - Fax:703-689-3889
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305211896225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist