Provider Demographics
NPI:1639945736
Name:KINNEY, SAMUEL (DPT)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:KINNEY
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 1:1401 CHAIN BRIDGE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3883
Mailing Address - Country:US
Mailing Address - Phone:703-712-8277
Mailing Address - Fax:
Practice Address - Street 1:1401 CHAIN BRIDGE RD STE 203
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3883
Practice Address - Country:US
Practice Address - Phone:703-712-8277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305215718225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist