Healthcare Provider Details

I. General information

NPI: 1992839880
Provider Name (Legal Business Name): KIMBERLY GUINEE MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700B GUNSTON PLZ
LORTON VA
22079-1897
US

IV. Provider business mailing address

7700B GUNSTON PLZ
LORTON VA
22079-1897
US

V. Phone/Fax

Practice location:
  • Phone: 703-339-3767
  • Fax: 703-339-3793
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305004528
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: