Provider Demographics
NPI:1881943397
Name:PESAVENTO, KATHY (PT)
Entity type:Individual
Prefix:DR
First Name:KATHY
Middle Name:
Last Name:PESAVENTO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 CHURCH ST NW STE 100B
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4434
Mailing Address - Country:US
Mailing Address - Phone:571-313-5785
Mailing Address - Fax:571-313-5785
Practice Address - Street 1:243 CHURCH ST NW STE 100B
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4434
Practice Address - Country:US
Practice Address - Phone:571-313-5785
Practice Address - Fax:571-313-5785
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305005364225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist