Provider Demographics
NPI:1649790734
Name:FATH, CHRISTINA (LMT)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:FATH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11757 BAYFIELD CT
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20194-1814
Mailing Address - Country:US
Mailing Address - Phone:703-626-8429
Mailing Address - Fax:
Practice Address - Street 1:6829 ELM ST STE 300
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3845
Practice Address - Country:US
Practice Address - Phone:703-532-4892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019006663225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
519576-06OtherBOARD CERTIFIED MASSAGE THERAPIST (BCTMB)
VA0019006663OtherMASSAGE THERAPIST