Provider Demographics
NPI:1891079208
Name:JOHNSON, KATHRYN ANNE (DPT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANNE
Last Name:JOHNSON
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 1:2665 PROSPERITY AVE
Mailing Address - Street 2:#117
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4917
Mailing Address - Country:US
Mailing Address - Phone:703-969-4940
Mailing Address - Fax:
Practice Address - Street 1:6862 ELM ST
Practice Address - Street 2:SUITE 105
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3897
Practice Address - Country:US
Practice Address - Phone:703-556-7788
Practice Address - Fax:703-556-9750
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207166225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist