Provider Demographics
NPI:1396744355
Name:QUINTANILLA, JENNIFER ANN (PT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:QUINTANILLA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8316 ARLINGTON BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-5207
Mailing Address - Country:US
Mailing Address - Phone:703-560-3190
Mailing Address - Fax:703-560-3194
Practice Address - Street 1:8316 ARLINGTON BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-5207
Practice Address - Country:US
Practice Address - Phone:703-205-1919
Practice Address - Fax:703-205-1977
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2305203683225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist