Basic Information
| Provider Information | |||||||||
| NPI: | 1518236587 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLOSNER | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | |||||||||
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| Credential: | DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SPALLHOLTZ | ||||||||
| OtherFirstName: | KELLY | ||||||||
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| OtherCredential: | DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 11240 WAPLES MILL RD | ||||||||
| Address2: | STE 403 | ||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220306078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033836454 | ||||||||
| FaxNumber: | 7038105494 | ||||||||
| Practice Location | |||||||||
| Address1: | 8320 OLD COURTHOUSE RD | ||||||||
| Address2: | STE 401 | ||||||||
| City: | VIENNA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221823831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033836454 | ||||||||
| FaxNumber: | 7038105494 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2011 | ||||||||
| LastUpdateDate: | 01/04/2012 | ||||||||
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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 | 2305207203 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.