Provider Demographics
NPI:1760502587
Name:KONE, VENKATA GIRIDHAR
Entity Type:Individual
Prefix:
First Name:VENKATA
Middle Name:GIRIDHAR
Last Name:KONE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25261 DOOLITTLE LN
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20152-6019
Mailing Address - Country:US
Mailing Address - Phone:571-230-7359
Mailing Address - Fax:
Practice Address - Street 1:25261 DOOLITTLE LN
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20152-6019
Practice Address - Country:US
Practice Address - Phone:571-230-7359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119004160225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist