Healthcare Provider Details

I. General information

NPI: 1649580242
Provider Name (Legal Business Name): KATHRYN W GRASSMEYER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6521 ARLINGTON BLVD SUITE 312
FALLS CHURCH VA
22042
US

IV. Provider business mailing address

4263 35TH ST S
ARLINGTON VA
22206
US

V. Phone/Fax

Practice location:
  • Phone: 703-536-1817
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2305206696
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: