Provider Demographics
NPI:1902022593
Name:HARWOOD, KENNETH JOSEPH (PT, PHD, CIE)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:JOSEPH
Last Name:HARWOOD
Suffix:
Gender:M
Credentials:PT, PHD, CIE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12551 MANDERLEY WAY
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-1828
Mailing Address - Country:US
Mailing Address - Phone:703-620-1170
Mailing Address - Fax:
Practice Address - Street 1:12551 MANDERLEY WAY
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-1828
Practice Address - Country:US
Practice Address - Phone:703-620-1170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203710225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist