Provider Demographics
NPI:1851185011
Name:DOLAN, KATHERINE SMITH (PTA)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:SMITH
Last Name:DOLAN
Suffix:
Gender:
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 MONTICELLO ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-3932
Mailing Address - Country:US
Mailing Address - Phone:804-916-9731
Mailing Address - Fax:
Practice Address - Street 1:1700 WILLOW LAWN DR STE 230
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3003
Practice Address - Country:US
Practice Address - Phone:804-340-1193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306606062225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant