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NPI Code Detail

MEDICARE: KELLY M PHILLIPS DPT

MEDICARE: KELLY M PHILLIPS 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 Therapist2305211175VA

General Provider Information

NPI Number : 1720517790
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY M PHILLIPS DPT
Provider Business Mailing Address
First Line : 43490 YUKON DR STE 212
Second Line :
City : ASHBURN
State : VA
Zip : 20147-7326
Country : US
Telephone Number : 703-729-7920
Fax Number :
Provider Business Practice Location Address
First Line : 43490 YUKON DR STE 212
Second Line :
City : ASHBURN
State : VA
Zip : 20147-7326
Country : US
Telephone Number : 703-729-7920
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2017
Last Update Date : 07/21/2022

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Directions to “ KELLY M PHILLIPS DPT” Practice Location

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