Basic Information
| Provider Information | |||||||||
| NPI: | 1396789293 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOLDEN | ||||||||
| FirstName: | KERRIE | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8183 PAPER BIRCH DR | ||||||||
| Address2: | |||||||||
| City: | LORTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220795653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7036465617 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5803 ARMY PENTAGON | ||||||||
| Address2: | CORRIDOR 8 THE PENTAGON | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 203101484 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7036928981 | ||||||||
| FaxNumber: | 2542867336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PTH1579 | AL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.