Provider Demographics
NPI:1740567361
Name:KAVANAGH, KATHERINE (DPT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:KAVANAGH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7521 VIRGINIA OAKS DR STE 240
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-3831
Mailing Address - Country:US
Mailing Address - Phone:703-753-7600
Mailing Address - Fax:703-753-8070
Practice Address - Street 1:1850 TOWN CENTER PKWY
Practice Address - Street 2:SUITE 403
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3219
Practice Address - Country:US
Practice Address - Phone:703-810-5203
Practice Address - Fax:703-810-5494
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist