Provider Demographics
NPI:1912079310
Name:DANDY, KEVIN M
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
Last Name:DANDY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4307 11TH ST N
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-4748
Mailing Address - Country:US
Mailing Address - Phone:703-351-9536
Mailing Address - Fax:
Practice Address - Street 1:11800 SUNRISE VALLEY DR
Practice Address - Street 2:100
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191
Practice Address - Country:US
Practice Address - Phone:703-709-1116
Practice Address - Fax:703-709-5134
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203243225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA189305Medicare UPIN