Provider Demographics
NPI:1518236587
Name:KLOSNER, KELLY (DPT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:KLOSNER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:SPALLHOLTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:11240 WAPLES MILL RD
Mailing Address - Street 2:STE 403
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6078
Mailing Address - Country:US
Mailing Address - Phone:703-383-6454
Mailing Address - Fax:703-810-5494
Practice Address - Street 1:8320 OLD COURTHOUSE RD
Practice Address - Street 2:STE 401
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3831
Practice Address - Country:US
Practice Address - Phone:703-383-6454
Practice Address - Fax:703-810-5494
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist