Healthcare Provider Details

I. General information

NPI: 1386077337
Provider Name (Legal Business Name): KATHLEEN MARY HARTER LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224-D CORNWALL STREET SUITE 200
LEESBURG VA
20175
US

IV. Provider business mailing address

44790 ASHLAR TER APT 002
ASHBURN VA
20147-4269
US

V. Phone/Fax

Practice location:
  • Phone: 703-443-2223
  • Fax:
Mailing address:
  • Phone: 703-723-2936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306000766
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: