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General NPI Number Information
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NPI Number | 1346631116
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Entity Type | Organization
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Legal Business Name | ADVANCED KINETICS PHYSICAL THERAPY
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Dates
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Enumeration Date | 02/13/2015
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Last Update Date | 01/28/2016
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Provider Practice Location Address
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Address Line | 510 W ANNANDALE RD SUITE 202
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City | FALLS CHURCH
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State | VA
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Zip | 22046-4226
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Country | US
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Telephone | 703-988-4664
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Fax | 571-295-7548
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Provider Business Mailing Address
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Address Line | 510 W ANNANDALE RD SUITE 202
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City | FALLS CHURCH
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State | VA
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Zip | 22046-4226
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Country | US
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Telephone | 703-988-4664
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Fax | 571-295-7548
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Authorized Official
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Title or Position | OWNER, PHYSICAL THERAPIST
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Name | MRS. ANGELA T GORDON
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Credential | PT
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Telephone | 703-988-4664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 2305203526
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License Number State | VA
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