Healthcare Provider Details

I. General information

NPI: 1780183608
Provider Name (Legal Business Name): JEAN ROSE GUTHRIE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9447 LORTON MARKET ST STE 250
LORTON VA
22079-1963
US

IV. Provider business mailing address

9447 LORTON MARKET ST STE 250
LORTON VA
22079-1963
US

V. Phone/Fax

Practice location:
  • Phone: 703-372-5716
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1301078
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305211748
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: