MEDICARE: KELLY LAUGHLIN

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	2251P0200X	Pediatric Physical Therapist	PT870156	DC
2	2251P0200X	Pediatric Physical Therapist	VA2305203045	VA

General Provider Information

NPI Number	:	1912475419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY LAUGHLIN

Provider Business Mailing Address
First Line	:	3544 36TH RD N
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22207-4817
Country	:	US
Telephone Number	:	703-402-7443
Fax Number	:

Provider Business Practice Location Address
First Line	:	3544 36TH RD N
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22207-4817
Country	:	US
Telephone Number	:	703-402-7443
Fax Number	:

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

Provider Enumeration Date	:	11/02/2018
Last Update Date	:	11/02/2018

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Directions to “ KELLY LAUGHLIN ” Practice Location

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