Healthcare Provider Details

I. General information

NPI: 1225267552
Provider Name (Legal Business Name): JADE JASMINE BENDER-BURNETT PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 11/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5517 EASTBOURNE DR
SPRINGFIELD VA
22151-1606
US

IV. Provider business mailing address

5517 EASTBOURNE DR
SPRINGFIELD VA
22151-1606
US

V. Phone/Fax

Practice location:
  • Phone: 812-639-2246
  • Fax:
Mailing address:
  • Phone: 812-639-2246
  • Fax: 703-894-4916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPT 2305207331
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: