Provider Demographics
NPI:1386128452
Name:SAPORITO, KERI (LPTA)
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:
Last Name:SAPORITO
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9906 MICHAEL SCHAR CT
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22181-5912
Mailing Address - Country:US
Mailing Address - Phone:571-455-0526
Mailing Address - Fax:
Practice Address - Street 1:12052 N SHORE DR
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-4969
Practice Address - Country:US
Practice Address - Phone:703-834-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306605187225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant