Provider Demographics
NPI:1346631116
Name:ADVANCED KINETICS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ADVANCED KINETICS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:T
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:703-988-4664
Mailing Address - Street 1:510 W ANNANDALE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-4226
Mailing Address - Country:US
Mailing Address - Phone:703-988-4664
Mailing Address - Fax:571-295-7548
Practice Address - Street 1:510 W ANNANDALE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-4226
Practice Address - Country:US
Practice Address - Phone:703-988-4664
Practice Address - Fax:571-295-7548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-13
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203526261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy