Provider Demographics
NPI:1437240348
Name:KENST, ELLEN MEREDITH (DPT)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:MEREDITH
Last Name:KENST
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22691 BLUE ELDER TER
Mailing Address - Street 2:UNIT 204
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148-4846
Mailing Address - Country:US
Mailing Address - Phone:330-936-3701
Mailing Address - Fax:
Practice Address - Street 1:13350 FRANKLIN FARM RD
Practice Address - Street 2:SUITE 300
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-4091
Practice Address - Country:US
Practice Address - Phone:703-234-1045
Practice Address - Fax:703-471-0280
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052046712251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic