Individual
KATHRYN GRAY LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
350 NEW FIDELITY CT, GARNER, NC 27529-2665
(919) 258-2714
(410) 648-4878
Mailing address
1195 HISEY AVE, WOODSTOCK, VA 22664-2097
(540) 459-7772
(540) 459-7782
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
2305211480
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2305211480
COMMONWEALTH OF VIRGINIA BOARD OF PHYSICAL THERAPY LICENSE
VA
Enumeration date
09/11/2017
Last updated
11/09/2018
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