MEDICARE: ELLEN MEREDITH KENST 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
1	2251X0800X	Orthopedic Physical Therapist	2305204671	VA

General Provider Information

NPI Number	:	1437240348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN MEREDITH KENST DPT

Provider Business Mailing Address
First Line	:	22691 BLUE ELDER TER
Second Line	:	UNIT 204
City	:	ASHBURN
State	:	VA
Zip	:	20148-4846
Country	:	US
Telephone Number	:	330-936-3701
Fax Number	:

Provider Business Practice Location Address
First Line	:	13350 FRANKLIN FARM RD
Second Line	:	SUITE 300
City	:	HERNDON
State	:	VA
Zip	:	20171-4091
Country	:	US
Telephone Number	:	703-234-1045
Fax Number	:	703-471-0280

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	07/08/2007

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