Basic Information
| Provider Information | |||||||||
| NPI: | 1285610949 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FORRER | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1119 | ||||||||
| Address2: | |||||||||
| City: | STEPHENS CITY | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226551119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5408689599 | ||||||||
| FaxNumber: | 5408689699 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 ELDEN ST | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | HERNDON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201704861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7036893737 | ||||||||
| FaxNumber: | 7036893889 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2005 | ||||||||
| LastUpdateDate: | 04/11/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305204141 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.