Provider Demographics
NPI:1790161933
Name:FRIES, KAILIN JESSICA (PTA)
Entity Type:Individual
Prefix:MS
First Name:KAILIN
Middle Name:JESSICA
Last Name:FRIES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 EXETER DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22603-8614
Mailing Address - Country:US
Mailing Address - Phone:540-665-0104
Mailing Address - Fax:540-665-1681
Practice Address - Street 1:160 EXETER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22603-8614
Practice Address - Country:US
Practice Address - Phone:540-665-0104
Practice Address - Fax:540-665-1681
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306604259225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant