Provider Demographics
NPI:1255760526
Name:BOLOGNESE, CHRISTINEB (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:CHRISTINEB
Middle Name:
Last Name:BOLOGNESE
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8606 JAMES CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1518
Mailing Address - Country:US
Mailing Address - Phone:703-644-7041
Mailing Address - Fax:
Practice Address - Street 1:10805 MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4729
Practice Address - Country:US
Practice Address - Phone:703-978-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305001490174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist