Provider Demographics
NPI:1639818552
Name:KWITNIESKI, KIRSTEN HELEN (ATC)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:HELEN
Last Name:KWITNIESKI
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 SHANKS EVANS RD NE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-6615
Mailing Address - Country:US
Mailing Address - Phone:703-862-4354
Mailing Address - Fax:
Practice Address - Street 1:708 SHANKS EVANS RD NE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-6615
Practice Address - Country:US
Practice Address - Phone:703-862-4354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA20000513052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer