Provider Demographics
NPI:1639224777
Name:MIDDLETON, KATHLEEN KELLEHER (PT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:KELLEHER
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:KELLEHER
Other - Last Name:WHITING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9123 VOLUNTEER DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22309-2922
Mailing Address - Country:US
Mailing Address - Phone:916-487-3473
Mailing Address - Fax:916-487-3483
Practice Address - Street 1:9447B LORTON MARKET ST
Practice Address - Street 2:SUITE 250
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-1963
Practice Address - Country:US
Practice Address - Phone:703-372-5716
Practice Address - Fax:703-372-5718
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208262225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT 33916OtherPHYSICAL THERAPY