Provider Demographics
NPI:1831936087
Name:KASOWSKI, JILLIAN KIM (PTA)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:KIM
Last Name:KASOWSKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:K
Other - Last Name:BEATTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7603 LONG PINE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151-2821
Mailing Address - Country:US
Mailing Address - Phone:701-805-8011
Mailing Address - Fax:
Practice Address - Street 1:3299 WOODBURN RD STE 310
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-7300
Practice Address - Country:US
Practice Address - Phone:170-384-9814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306606596225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant