Provider Demographics
NPI:1376543132
Name:KERNS, JACQUELINE (PT)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:KERNS
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 1:9900 MAIN ST
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3907
Mailing Address - Country:US
Mailing Address - Phone:703-279-4394
Mailing Address - Fax:703-279-4214
Practice Address - Street 1:6201 CENTREVILLE RD
Practice Address - Street 2:SUITE 500
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2626
Practice Address - Country:US
Practice Address - Phone:703-263-2095
Practice Address - Fax:703-263-2098
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204295225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist