Provider Demographics
NPI:1043892078
Name:LOVING, KIERAN PAUL (ATC)
Entity Type:Individual
Prefix:MR
First Name:KIERAN
Middle Name:PAUL
Last Name:LOVING
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11992 MOLLY PITCHER CIR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-4800
Mailing Address - Country:US
Mailing Address - Phone:703-505-0643
Mailing Address - Fax:
Practice Address - Street 1:12731 MARBLESTONE DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-8333
Practice Address - Country:US
Practice Address - Phone:571-659-2612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT85062255A2300X
VA01260012592255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty