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General NPI Number Information
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NPI Number | 1295828242
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Entity Type | Individual
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Provider Name | JENNIFER LEITCH MCCRADY DPT
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Gender | Female
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 02/27/2012
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Provider Practice Location Address
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Address Line | 600 E MAIN ST STE A SUITE A
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City | RADFORD
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State | VA
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Zip | 24141-1826
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Country | US
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Telephone | 540-633-0413
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Fax | 540-633-0416
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Provider Business Mailing Address
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Address Line | 825 DAVIS ST SUITE B
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City | BLACKSBURG
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State | VA
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Zip | 24060-7013
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Country | US
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Telephone | 540-552-5100
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Fax | 540-552-5700
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305204219
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License Number State | VA
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