Provider Demographics
NPI:1508870320
Name:KONCHAR, JENNIFER OLEK (MSPT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:OLEK
Last Name:KONCHAR
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 715868
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19171-5868
Mailing Address - Country:US
Mailing Address - Phone:804-915-1910
Mailing Address - Fax:804-968-1803
Practice Address - Street 1:8270 WILLOW OAKS CORPORATE DR STE 700
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4529
Practice Address - Country:US
Practice Address - Phone:703-810-5218
Practice Address - Fax:703-810-5406
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202318225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA014151C95Medicare ID - Type Unspecified