Jeanie Bridwell

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

0019014296 Issued in VA

Practice address

1801 Robert Fulton Dr # 230
Reston, VA 20191-5461

Phone

(571) 449-6839

NPI assigned

Sep 19, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1695081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695081600000",
    "number": "1689452708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44485 POTTER TER",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "201477156",
            "telephone_number": "919-869-0589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 ROBERT FULTON DR # 230",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201915461",
            "telephone_number": "571-449-6839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRIDWELL",
        "first_name": "JEANIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-09-19",
        "last_updated": "2023-09-19",
        "certification_date": "2023-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "VA",
            "license": "0019014296",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Allison Claire Brandmark
• Elizabeth Ann Brantley, MD
• Bethann Brennan, LMT
• Darren Christopher Brennan, PSYD
• Alexandra Brezinsky
• Sandra Deal Briggs, P.T.
• Claudia Andrea Bright
• Michael Dean Britt, LPC
• Mary Tiernan Brough, L.P.C.
• Carl Theodore Brown, MD

• Massage Therapist in Reston, VA
• Providers in Reston, VA by specialty
• Massage Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.