Healthcare Provider Details

I. General information

NPI: 1801204060
Provider Name (Legal Business Name): J2 THERAPY AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2014
Last Update Date: 06/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46161 WESTLAKE DR SUITE 330
STERLING VA
20165-5871
US

IV. Provider business mailing address

46161 WESTLAKE DR SUITE 330
STERLING VA
20165-5871
US

V. Phone/Fax

Practice location:
  • Phone: 703-444-9562
  • Fax: 703-430-2124
Mailing address:
  • Phone: 703-444-9562
  • Fax: 703-430-2124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE M NYREN
Title or Position: OWNER
Credential: MSPT
Phone: 703-444-9562