Provider Demographics
NPI:1417071598
Name:KANNAN, VIDHYA
Entity Type:Individual
Prefix:
First Name:VIDHYA
Middle Name:
Last Name:KANNAN
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 1:21785 FILIGREE CT
Mailing Address - Street 2:#103
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-6213
Mailing Address - Country:US
Mailing Address - Phone:703-444-5447
Mailing Address - Fax:703-444-5484
Practice Address - Street 1:21785 FILIGREE CT
Practice Address - Street 2:#103
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-6213
Practice Address - Country:US
Practice Address - Phone:703-444-5447
Practice Address - Fax:703-444-5484
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205198225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist