Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | VA |
NPI | 1003267857 |
---|---|
Provider Name | Brett Alexandria Kulp |
First Address | Ashburn, VA 20147-6990 |
Second Address | Ashburn, VA 20147-6990 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2016 |
Last Update Date | 17/06/2020 |