Provider Demographics
NPI:1033265087
Name:HORTON, KIMBERLY A (PT)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:A
Last Name:HORTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:ROCQUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:44927 GEORGE WASHINGTON BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-4295
Mailing Address - Country:US
Mailing Address - Phone:571-291-9936
Mailing Address - Fax:571-918-4935
Practice Address - Street 1:44927 GEORGE WASHINGTON BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-4295
Practice Address - Country:US
Practice Address - Phone:571-291-9936
Practice Address - Fax:571-918-4935
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203754225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist