Provider Demographics
NPI:1114619319
Name:KETTERER, KARINGTON NICOLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KARINGTON
Middle Name:NICOLE
Last Name:KETTERER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 WILSON BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-2505
Mailing Address - Country:US
Mailing Address - Phone:703-935-1996
Mailing Address - Fax:
Practice Address - Street 1:1600 WILSON BLVD STE 102
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-2505
Practice Address - Country:US
Practice Address - Phone:703-935-1996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV004645208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation