Provider Demographics
NPI:1346599040
Name:HESS, KATHLEEN S (PT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:S
Last Name:HESS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15611 ANDOVER HEIGHTS DR.
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-1072
Mailing Address - Country:US
Mailing Address - Phone:703-583-6899
Mailing Address - Fax:703-583-6899
Practice Address - Street 1:15611 ANDOVER HEIGHTS DR.
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-1072
Practice Address - Country:US
Practice Address - Phone:703-583-6899
Practice Address - Fax:703-583-6899
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305005991225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP12070(OLD)Medicare UPIN