Provider Demographics
NPI:1962467480
Name:PASSINO, JENNIFER MARIE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE
Last Name:PASSINO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:KNIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS PT
Mailing Address - Street 1:12552 SWEET LEAF TERRACE
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2462
Mailing Address - Country:US
Mailing Address - Phone:703-385-3910
Mailing Address - Fax:
Practice Address - Street 1:10525 WEST DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4230
Practice Address - Country:US
Practice Address - Phone:703-934-9411
Practice Address - Fax:703-934-9497
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203253225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG02052OtherMEDICARE GROUP PIN
DCG02052OtherMEDICARE GROUP PIN