Provider Demographics
NPI:1750971859
Name:COOPER, CHRISTINE HONOR (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:HONOR
Last Name:COOPER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:CHRISTINE
Other - Middle Name:HONOR
Other - Last Name:FREUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2114 GREEN WATCH WAY UNIT 301
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-2424
Mailing Address - Country:US
Mailing Address - Phone:703-629-9284
Mailing Address - Fax:
Practice Address - Street 1:22556 AMENDOLA TER STE 130
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20148-2412
Practice Address - Country:US
Practice Address - Phone:571-465-9289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214064225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist