Provider Demographics
NPI:1891570032
Name:KIMMEL, ALESHA DAWN (DPT, PT)
Entity Type:Individual
Prefix:DR
First Name:ALESHA
Middle Name:DAWN
Last Name:KIMMEL
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:16074 JOHN QUICK RD
Mailing Address - Street 2:
Mailing Address - City:QUANTICO
Mailing Address - State:VA
Mailing Address - Zip Code:22134-1957
Mailing Address - Country:US
Mailing Address - Phone:724-793-0494
Mailing Address - Fax:
Practice Address - Street 1:14524 POTOMAC MILLS RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-6803
Practice Address - Country:US
Practice Address - Phone:703-490-6726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305215942225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist