Individual
JEANIE BRIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1801 ROBERT FULTON DR # 230, RESTON, VA 20191-5461
(571) 449-6839
Mailing address
44485 POTTER TER, ASHBURN, VA 20147-7156
(919) 869-0589
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
0019014296
VA
Other
Enumeration date
09/19/2023
Last updated
09/19/2023
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