Healthcare Provider Details

I. General information

NPI: 1063046290
Provider Name (Legal Business Name): KELLY HILTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11507 SUNSET HILLS RD
RESTON VA
20190-4704
US

IV. Provider business mailing address

11507 SUNSET HILLS RD
RESTON VA
20190-4704
US

V. Phone/Fax

Practice location:
  • Phone: 301-798-4838
  • Fax:
Mailing address:
  • Phone: 301-798-4838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number298177
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number298177
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2305217563
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: