Healthcare Provider Details

I. General information

NPI: 1851185011
Provider Name (Legal Business Name): KATHERINE SMITH DOLAN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2025
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 WILLOW LAWN DR STE 230
RICHMOND VA
23230-3003
US

IV. Provider business mailing address

4020 MONTICELLO ST
RICHMOND VA
23227-3932
US

V. Phone/Fax

Practice location:
  • Phone: 804-340-1193
  • Fax:
Mailing address:
  • Phone: 804-916-9731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306606062
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: