Provider Demographics
NPI:1427320878
Name:JAGGER, KRISTEN L (PT, PHD, OCS)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:L
Last Name:JAGGER
Suffix:
Gender:F
Credentials:PT, PHD, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 358
Mailing Address - Street 2:
Mailing Address - City:CLOVERDALE
Mailing Address - State:VA
Mailing Address - Zip Code:24077
Mailing Address - Country:US
Mailing Address - Phone:540-985-0500
Mailing Address - Fax:540-985-0529
Practice Address - Street 1:1015 FIRST STREET SW SUITE 2
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016
Practice Address - Country:US
Practice Address - Phone:540-985-0500
Practice Address - Fax:540-985-0529
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206995208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation