Provider Demographics
NPI:1295321719
Name:SWEENEY, KAYLA A (PT, DPT)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:A
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 WRENN HOUSE CT
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-3955
Mailing Address - Country:US
Mailing Address - Phone:703-740-6613
Mailing Address - Fax:
Practice Address - Street 1:6201 CENTREVILLE RD STE 500
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2634
Practice Address - Country:US
Practice Address - Phone:703-263-2095
Practice Address - Fax:703-263-2098
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214095225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist