Provider Demographics
NPI:1841434412
Name:FLORES, KATHLEEN NOONAN
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:NOONAN
Last Name:FLORES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16173 DILIGENCE CT
Mailing Address - Street 2:
Mailing Address - City:BEAVERDAM
Mailing Address - State:VA
Mailing Address - Zip Code:23015-1570
Mailing Address - Country:US
Mailing Address - Phone:804-304-9524
Mailing Address - Fax:
Practice Address - Street 1:16173 DILIGENCE CT
Practice Address - Street 2:
Practice Address - City:BEAVERDAM
Practice Address - State:VA
Practice Address - Zip Code:23015-1570
Practice Address - Country:US
Practice Address - Phone:804-304-9524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305005699225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist