Healthcare Provider Details

I. General information

NPI: 1710704861
Provider Name (Legal Business Name): JENNIFER BERMUDEZ LMT, CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2024
Last Update Date: 09/20/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 CRYSTAL DRIVE (SPA ROOM) CONCORD APARTMENTS CRYSTAL CITY (RESIDENTS)
ARLINGTON VA
22202
US

IV. Provider business mailing address

9228 LANDGREEN ST
MANASSAS VA
20110-4861
US

V. Phone/Fax

Practice location:
  • Phone: 703-479-8207
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019020013
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: