Provider Demographics
NPI:1295828242
Name:MCCRADY, JENNIFER LEITCH (DPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEITCH
Last Name:MCCRADY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:LEITCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:825 DAVIS ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-7013
Mailing Address - Country:US
Mailing Address - Phone:540-552-5100
Mailing Address - Fax:540-552-5700
Practice Address - Street 1:600 E MAIN ST STE A
Practice Address - Street 2:SUITE A
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-1826
Practice Address - Country:US
Practice Address - Phone:540-633-0413
Practice Address - Fax:540-633-0416
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204219225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2618376 GROUPOtherMAMSI
VA192943OtherANTHEM
VA263354OtherSOUTHERN HEALTH