Healthcare Provider Details

I. General information

NPI: 1659536308
Provider Name (Legal Business Name): KIMBERLY ORTANEZ ENDERES DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 05/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21475 RIDGETOP CIR STE 150
STERLING VA
20166-6580
US

IV. Provider business mailing address

516 HERNDON PKWY SUITE D
HERNDON VA
20170
US

V. Phone/Fax

Practice location:
  • Phone: 703-433-2500
  • Fax: 703-433-2558
Mailing address:
  • Phone: 703-779-3631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305205506
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: