Individual
MS. JACQUELINE JOANNE CORRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
8575 RIXLEW LN, MANASSAS, VA 20109-3701
(703) 257-9770
(703) 257-2937
Mailing address
8575 RIXLEW LN, MANASSAS, VA 20109-3701
(703) 257-9770
(703) 257-2937
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305206779
VA
225100000X
Physical Therapist
3777512401
UT
225100000X
Physical Therapist
PT00009564
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0190045
DEPT. LABOR & INDUSTRIES
WA
01
—
292104132
TRICARE
WA
05
—
8422248
—
WA
01
—
9171CO
REGENCE BLUESHIELD
WA
Enumeration date
07/07/2005
Last updated
07/11/2011
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