Provider Demographics
NPI:1124593777
Name:CONNER, JEANNE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:CONNER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4229 LAFAYETTE CENTER DR STE 1250
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1266
Mailing Address - Country:US
Mailing Address - Phone:703-263-2020
Mailing Address - Fax:703-263-2015
Practice Address - Street 1:7700B GUNSTON PLZ
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-1897
Practice Address - Country:US
Practice Address - Phone:703-339-3767
Practice Address - Fax:703-339-3793
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305212380225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA23052112380OtherPT LISCENCE