Provider Demographics
NPI:1013170356
Name:LINN, JENNIFER BALLA (DPT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:BALLA
Last Name:LINN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:M
Other - Last Name:BALLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:80 E JEFFERSON STREET
Mailing Address - Street 2:200
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3568
Mailing Address - Country:US
Mailing Address - Phone:703-237-2000
Mailing Address - Fax:703-237-2155
Practice Address - Street 1:80 E JEFFERSON STREET
Practice Address - Street 2:200
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3568
Practice Address - Country:US
Practice Address - Phone:703-237-2000
Practice Address - Fax:703-237-2155
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205484225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA141379ZADXMedicare PIN