Provider Demographics
NPI:1811470446
Name:SAMMONS, KATHERINE
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:SAMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHERIN
Other - Middle Name:ELINOR
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1769
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20118-1769
Mailing Address - Country:US
Mailing Address - Phone:703-729-7920
Mailing Address - Fax:709-729-7923
Practice Address - Street 1:43490 YUKON DR STE 212
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-7326
Practice Address - Country:US
Practice Address - Phone:703-729-7920
Practice Address - Fax:703-729-7923
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305212333225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist