1366466559 NPI number — JENNIFER CRISTIN MASTERS D.P.T.

Table of content: JENNIFER CRISTIN MASTERS D.P.T. (NPI 1366466559)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366466559 NPI number — JENNIFER CRISTIN MASTERS D.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MASTERS
Provider First Name:
JENNIFER
Provider Middle Name:
CRISTIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RAMIREZ
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
CRISTIN BOAST
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT, DPT, COMT, BCTMB
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1366466559
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15401 MADISON RUN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GORDONSVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22942-8723
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-672-0233
Provider Business Mailing Address Fax Number:
540-972-9516

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 MERCHANT WALK AVE STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTESVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22902-6520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-328-4900
Provider Business Practice Location Address Fax Number:
434-295-0420
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2305202950 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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