Active NPI
Kathryn Elizabeth Canyon, PTA
- Physical Therapy Assistant
- Fairfax, VA
National Provider Identifier
1245593029
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2306602837
- Practice address
- 4001 Fair Ridge Dr
Suite 203
Fairfax, VA 22033-2917 - Phone
- (703) 865-7680
- Fax
- (703) 865-7683
- NPI assigned
- Jun 18, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 2306602837 | VA | Primary |
Addresses
Primary practice location
4001 Fair Ridge Dr
Suite 203
Fairfax, VA 22033-2917
Mailing address
11084 Wainwright PL
Manassas, VA 20109-8274
Phone (703) 881-8201
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2306602837 | VA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339977600000",
"number": "1245593029",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11084 WAINWRIGHT PL",
"city": "MANASSAS",
"state": "VA",
"postal_code": "201098274",
"telephone_number": "703-881-8201"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4001 FAIR RIDGE DR",
"address_2": "SUITE 203",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220332917",
"telephone_number": "703-865-7680",
"fax_number": "703-865-7683"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANYON",
"first_name": "KATHRYN",
"middle_name": "ELIZABETH",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-06-18",
"last_updated": "2012-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "VA",
"license": "2306602837",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfax, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.