Individual
MISS JACKALYN NICOLE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
9860 FAIRFAX BLVD, SUITE 1, FAIRFAX, VA 22030-1737
(703) 383-1616
(703) 383-1166
Mailing address
9860 FAIRFAX BLVD, SUITE 1, FAIRFAX, VA 22030-1737
(703) 383-1616
(703) 383-1166
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
2305206191
VA
Other
Enumeration date
09/29/2009
Last updated
11/14/2016
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