Healthcare Provider Details

I. General information

NPI: 1184970717
Provider Name (Legal Business Name): JACQUELYN M ROSOFF PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELYN M RIGGLES

II. Dates (important events)

Enumeration Date: 08/01/2012
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13854 SMOKETOWN RD
WOODBRIDGE VA
22192-4210
US

IV. Provider business mailing address

5252 LYNGATE CT #203
BURKE VA
22015-1672
US

V. Phone/Fax

Practice location:
  • Phone: 703-670-9935
  • Fax: 703-670-9939
Mailing address:
  • Phone: 703-239-2300
  • Fax: 703-239-2301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305207476
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: