Provider Demographics
NPI:1235388182
Name:CULAK, JENNIFER WILLIAMS (DPT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:WILLIAMS
Last Name:CULAK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2170 GABORONE PL APT 14
Mailing Address - Street 2:
Mailing Address - City:DULLES
Mailing Address - State:VA
Mailing Address - Zip Code:20189-2170
Mailing Address - Country:US
Mailing Address - Phone:361-548-9447
Mailing Address - Fax:
Practice Address - Street 1:2170 GABORONE PL APT 14
Practice Address - Street 2:
Practice Address - City:DULLES
Practice Address - State:VA
Practice Address - Zip Code:20189-2170
Practice Address - Country:US
Practice Address - Phone:361-548-9447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23449225100000X
NCP15488225100000X
VA2305213768225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist