Provider Demographics
NPI:1902350242
Name:HOOVER, CRISTIE (PTA)
Entity Type:Individual
Prefix:
First Name:CRISTIE
Middle Name:
Last Name:HOOVER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8501 BUCKEYE CT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4630
Mailing Address - Country:US
Mailing Address - Phone:703-309-4940
Mailing Address - Fax:
Practice Address - Street 1:8501 BUCKEYE CT
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4630
Practice Address - Country:US
Practice Address - Phone:703-309-4940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306604495225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant