Healthcare Provider Details

I. General information

NPI: 1407417660
Provider Name (Legal Business Name): KEVIN TENG DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5663 COLUMBIA PIKE
FALLS CHURCH VA
22041
US

IV. Provider business mailing address

21475 RIDGETOP CIR STE 260
STERLING VA
20166-8580
US

V. Phone/Fax

Practice location:
  • Phone: 240-449-5623
  • Fax:
Mailing address:
  • Phone: 703-433-2500
  • Fax: 703-433-2558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305212881
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: