Provider Demographics
NPI:1306091210
Name:SUMMERS, JEVENE MARIE (MSPT)
Entity type:Individual
Prefix:
First Name:JEVENE
Middle Name:MARIE
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6320 9TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-1115
Mailing Address - Country:US
Mailing Address - Phone:703-328-7076
Mailing Address - Fax:
Practice Address - Street 1:3260 WILSON BLVD STE 21E
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-4423
Practice Address - Country:US
Practice Address - Phone:703-963-5695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2305202400OtherVIRGINIA STATE BOARD PHYSICAL THERAPY LICENSE