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NPI Code Detail

MEDICARE: DR. WILLIAM GLYNN KOTULAN PHYSICAL THERAPIST

MEDICARE: DR. WILLIAM GLYNN KOTULAN PHYSICAL THERAPIST
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist2305006781VA

General Provider Information

NPI Number : 1114907037
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WILLIAM GLYNN KOTULAN PHYSICAL THERAPIST
Provider Business Mailing Address
First Line : 3700 FETTLER PARK DR
Second Line :
City : DUMFRIES
State : VA
Zip : 22025-2050
Country : US
Telephone Number : 703-441-7500
Fax Number :
Provider Business Practice Location Address
First Line : 3700 FETTLER PARK DR
Second Line :
City : DUMFRIES
State : VA
Zip : 22025-2050
Country : US
Telephone Number : 703-441-7500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2006
Last Update Date : 03/28/2024

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