Provider Demographics
NPI:1609045525
Name:SMALL, JENNIFER WOODARD (DPT, WCS, OCS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:WOODARD
Last Name:SMALL
Suffix:
Gender:F
Credentials:DPT, WCS, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19309 WINMEADE DR
Mailing Address - Street 2:NUMBER 111
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-6507
Mailing Address - Country:US
Mailing Address - Phone:703-283-3311
Mailing Address - Fax:
Practice Address - Street 1:20098 ASHBROOK PL
Practice Address - Street 2:SUITE 190
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-3393
Practice Address - Country:US
Practice Address - Phone:703-283-3311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23050056722251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic