Provider Demographics
NPI:1245615251
Name:GILLETTE, KATHRYN
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:GILLETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43490 YUKON DR
Mailing Address - Street 2:STE 212
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-6990
Mailing Address - Country:US
Mailing Address - Phone:703-729-7920
Mailing Address - Fax:
Practice Address - Street 1:43490 YUKON DR
Practice Address - Street 2:STE 212
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-6990
Practice Address - Country:US
Practice Address - Phone:703-729-7920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2305209599OtherLICENSE NUMBER