Provider Demographics
NPI:1508870320
Name:KONCHAR, JENNIFER OLEK (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:OLEK
Last Name:KONCHAR
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:11240 WAPLES MILL ROAD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030
Mailing Address - Country:US
Mailing Address - Phone:703-383-6454
Mailing Address - Fax:703-810-5494
Practice Address - Street 1:8501 ARLINGTON BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4617
Practice Address - Country:US
Practice Address - Phone:703-810-5218
Practice Address - Fax:703-810-5494
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2305202318225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA014151C95Medicare ID - Type Unspecified