Provider Demographics
NPI:1285610949
Name:FORRER, KEVIN D (DPT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:D
Last Name:FORRER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1119
Mailing Address - Street 2:
Mailing Address - City:STEPHENS CITY
Mailing Address - State:VA
Mailing Address - Zip Code:22655-1119
Mailing Address - Country:US
Mailing Address - Phone:540-868-9599
Mailing Address - Fax:540-868-9699
Practice Address - Street 1:150 ELDEN ST
Practice Address - Street 2:SUITE 240
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4861
Practice Address - Country:US
Practice Address - Phone:703-689-3737
Practice Address - Fax:703-689-3889
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204141225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG01886T02Medicare ID - Type Unspecified
DCQ36474Medicare UPIN