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NPI Code Detail

MEDICARE: KERRIE JEAN GOLDEN DPT

MEDICARE: KERRIE JEAN GOLDEN 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 TherapistPTH1579AL

General Provider Information

NPI Number : 1396789293
Entity Type Code : Individual
Provider Name (Legal Business Name) : KERRIE JEAN GOLDEN DPT
Provider Business Mailing Address
First Line : 13353 MARIE DR
Second Line :
City : MANASSAS
State : VA
Zip : 20112-4723
Country : US
Telephone Number : 703-909-7406
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 : 703-441-7658
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2006
Last Update Date : 04/05/2024

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