Provider Demographics
NPI:1023347051
Name:FORTIN, ANNA (DPT COMT CKTP)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:
Last Name:FORTIN
Suffix:
Gender:F
Credentials:DPT COMT CKTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 EAST JEFFERSON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3567
Mailing Address - Country:US
Mailing Address - Phone:703-237-2000
Mailing Address - Fax:703-237-2155
Practice Address - Street 1:80 EAST JEFFERSON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3567
Practice Address - Country:US
Practice Address - Phone:703-237-2000
Practice Address - Fax:703-237-2155
Is Sole Proprietor?:No
Enumeration Date:2009-12-22
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
VA2305206283225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist