Provider Demographics
NPI:1356099519
Name:STOVER, JILLIAN T (DPT)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:T
Last Name:STOVER
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:
Other - Last Name:IMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2501 PARKERS LN STE 200
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3209
Mailing Address - Country:US
Mailing Address - Phone:703-892-6500
Mailing Address - Fax:703-521-3415
Practice Address - Street 1:2501 PARKERS LN STE 200
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3209
Practice Address - Country:US
Practice Address - Phone:703-892-6500
Practice Address - Fax:703-521-3415
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214899225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist