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NPI Code Detail

MEDICARE: KELLIE N WADSWORTH DPT

MEDICARE: KELLIE N WADSWORTH DPT
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 Therapist2305209869VA

General Provider Information

NPI Number : 1306211347
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLIE N WADSWORTH DPT
Provider Business Mailing Address
First Line : 10716 RICHMOND HWY STE 103
Second Line :
City : LORTON
State : VA
Zip : 22079-2645
Country : US
Telephone Number : 703-892-6500
Fax Number : 703-521-3415
Provider Business Practice Location Address
First Line : 10716 RICHMOND HWY STE 103
Second Line :
City : LORTON
State : VA
Zip : 22079-2645
Country : US
Telephone Number : 703-892-6500
Fax Number : 703-521-3415
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2015
Last Update Date : 03/15/2024

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Directions to “ KELLIE N WADSWORTH DPT” Practice Location

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