Basic Information
| Provider Information | |||||||||
| NPI: | 1205068277 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURDA | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1769 | ||||||||
| Address2: | |||||||||
| City: | MIDDLEBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201181769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406878181 | ||||||||
| FaxNumber: | 5406878256 | ||||||||
| Practice Location | |||||||||
| Address1: | 8140 ASHTON AVE | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | MANASSAS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201095698 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032573333 | ||||||||
| FaxNumber: | 7032570066 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2009 | ||||||||
| LastUpdateDate: | 12/22/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305206110 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.