Healthcare Provider Details

I. General information

NPI: 1164345641
Provider Name (Legal Business Name): MS. JENNIFER MANEEMACHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 WILSON BLVD STE 700-52
ARLINGTON VA
22209-2464
US

IV. Provider business mailing address

1550 WILSON BLVD STE 700-52
ARLINGTON VA
22209-2464
US

V. Phone/Fax

Practice location:
  • Phone: 201-757-3198
  • Fax:
Mailing address:
  • Phone: 201-757-3198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019020489
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: