Provider Demographics
NPI:1912434960
Name:KEREY, JADEH (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:JADEH
Middle Name:
Last Name:KEREY
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DONNA DALE DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBRG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-2834
Mailing Address - Country:US
Mailing Address - Phone:703-986-8433
Mailing Address - Fax:
Practice Address - Street 1:10 DONNA DALE DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBRG
Practice Address - State:VA
Practice Address - Zip Code:22405-2834
Practice Address - Country:US
Practice Address - Phone:703-986-8433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-20
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260032742255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer