Healthcare Provider Details

I. General information

NPI: 1396745964
Provider Name (Legal Business Name): KATHLEEN WEBSTER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8348 TRAFORD LN SUTIE 100
SPRINGFIELD VA
22152-1663
US

IV. Provider business mailing address

9900 MAIN ST SUITE 200A
FAIRFAX VA
22031-3907
US

V. Phone/Fax

Practice location:
  • Phone: 703-569-7335
  • Fax: 703-569-0665
Mailing address:
  • Phone: 703-279-4394
  • Fax: 703-279-4214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305002485
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: