Provider Demographics
NPI:1467428383
Name:FANG, KEVIN S (DPT)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:S
Last Name:FANG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5208 30TH ST N
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-1802
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4601 FAIRFAX DR
Practice Address - Street 2:SUITE # 100
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1500
Practice Address - Country:US
Practice Address - Phone:703-841-0395
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204193225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist