Healthcare Provider Details

I. General information

NPI: 1962687152
Provider Name (Legal Business Name): KATHERINE LEANDRA CLAYTON CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5275 LEE HWY STE.200
ARLINGTON VA
22207-1619
US

IV. Provider business mailing address

5275 LEE HWY STE.200
ARLINGTON VA
22207-1619
US

V. Phone/Fax

Practice location:
  • Phone: 703-532-4892
  • Fax: 703-237-3105
Mailing address:
  • Phone: 703-532-4892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number0019001418
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: