Provider Demographics
NPI:1962432765
Name:SO, JAMIE M (DPT)
Entity type:Individual
Prefix:MISS
First Name:JAMIE
Middle Name:M
Last Name:SO
Suffix:
Gender:F
Credentials:DPT
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Mailing Address - Street 1:1204 N INGLEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-2461
Mailing Address - Country:US
Mailing Address - Phone:703-622-0603
Mailing Address - Fax:
Practice Address - Street 1:7900 WESTPARK DR STE A30
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-4241
Practice Address - Country:US
Practice Address - Phone:703-650-8824
Practice Address - Fax:703-848-0889
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2020-02-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA23052036392251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA01599O998Medicare PIN
VAG01837M01Medicare PIN