1538196431 NPI number — MRS. KRISTEN JUNE EDMA MS, ATC

Table of content: MRS. KRISTEN JUNE EDMA MS, ATC (NPI 1538196431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538196431 NPI number — MRS. KRISTEN JUNE EDMA MS, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EDMA
Provider First Name:
KRISTEN
Provider Middle Name:
JUNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538196431
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2911 S. WOODSTOCK ST.
Provider Second Line Business Mailing Address:
APT. F
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-578-1032
Provider Business Mailing Address Fax Number:
301-365-6023

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7303 RIVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20817-4640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-365-6467
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)