Provider Demographics
NPI:1164627220
Name:PRATT, JENNIFER R (CERT MASTECTOMY FTR)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:R
Last Name:PRATT
Suffix:
Gender:F
Credentials:CERT MASTECTOMY FTR
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:GENISE
Other - Last Name:REA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2513 IRON FORGE RD
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:VA
Mailing Address - Zip Code:20171-2950
Mailing Address - Country:US
Mailing Address - Phone:703-579-5799
Mailing Address - Fax:
Practice Address - Street 1:50 S PICKETT ST
Practice Address - Street 2:SUITE 210
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-7206
Practice Address - Country:US
Practice Address - Phone:703-461-7534
Practice Address - Fax:703-461-7534
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter