Provider Demographics
NPI:1730266552
Name:FREEBURN, KEITH JOHN (DPT)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:JOHN
Last Name:FREEBURN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14605 POTOMAC BRANCH DR STE 300
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3337
Mailing Address - Country:US
Mailing Address - Phone:703-490-1112
Mailing Address - Fax:703-878-8735
Practice Address - Street 1:14605 POTOMAC BRANCH DR STE 300
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3337
Practice Address - Country:US
Practice Address - Phone:703-490-1112
Practice Address - Fax:703-878-8735
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202949225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist