Provider Demographics
NPI:1538196431
Name:EDMA, KRISTEN JUNE (MS, ATC)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:JUNE
Last Name:EDMA
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2911 S. WOODSTOCK ST.
Mailing Address - Street 2:APT. F
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206
Mailing Address - Country:US
Mailing Address - Phone:703-578-1032
Mailing Address - Fax:301-365-6023
Practice Address - Street 1:7303 RIVER RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-4640
Practice Address - Country:US
Practice Address - Phone:301-365-6467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer