Individual
JENNIFER GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6850 VERSAR CTR, #241, SPRINGFIELD, VA 22151-4175
(703) 256-3400
Mailing address
7712 VICEROY ST, SPRINGFIELD, VA 22151-2729
(703) 644-1610
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2305204163
LICENSE #
VA
Enumeration date
08/30/2006
Last updated
07/08/2007
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