Individual
KERRY L CONWAY SHORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT, ATC
Contact information
Practice address
4375 FAIR LAKES CT, FAIRFAX, VA 22033-4234
(571) 432-2600
Mailing address
11160 S LAKES DR STE C1-264, RESTON, VA 20191-4327
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PTL-10528
CO
2255A2300X
Athletic Trainer
0126002535
VA
2255A2300X
Athletic Trainer
AT-794
CO
Other
Enumeration date
07/15/2008
Last updated
04/01/2024
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