Provider Demographics
NPI:1194244277
Name:LONG, KATHRYN GRAY (DPT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:GRAY
Last Name:LONG
Suffix:
Gender:F
Credentials:DPT
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Mailing Address - Street 1:1195 HISEY AVE
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22664-2097
Mailing Address - Country:US
Mailing Address - Phone:540-459-7772
Mailing Address - Fax:540-459-7782
Practice Address - Street 1:350 NEW FIDELITY CT
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-2665
Practice Address - Country:US
Practice Address - Phone:919-258-2714
Practice Address - Fax:410-648-4878
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2018-11-09
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Provider Licenses
StateLicense IDTaxonomies
VA2305211480208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2305211480OtherCOMMONWEALTH OF VIRGINIA BOARD OF PHYSICAL THERAPY LICENSE