Provider Demographics
NPI:1740786375
Name:KRAINER, JENNIFER JEANINE (DPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JEANINE
Last Name:KRAINER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:JEANINE
Other - Last Name:KOPPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1420 BEVERLY RD STE 210
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3736
Mailing Address - Country:US
Mailing Address - Phone:703-288-8260
Mailing Address - Fax:703-288-9316
Practice Address - Street 1:1420 BEVERLY RD STE 210
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3736
Practice Address - Country:US
Practice Address - Phone:703-288-8260
Practice Address - Fax:703-288-9316
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305212268225100000X
KY005297225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist