Individual provider Active NPI

Jamie M So, DPT

  • Orthopedic Physical Therapist
  • MC Lean, VA
National Provider Identifier
1962432765
Registry record updated Feb 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
2305203639 Issued in VA
Practice address
7900 Westpark Dr Ste A30
MC Lean, VA 22102-4241
Phone
(703) 650-8824
Fax
(703) 848-0889
NPI assigned
Jul 4, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 22, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical Therapist 2251X0800X 2305203639 VA Primary

Addresses

Primary practice location

7900 Westpark Dr Ste A30
MC Lean, VA 22102-4241

Mailing address

1204 N Inglewood St
Arlington, VA 22205-2461
Phone (703) 622-0603

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2305203639VAMDOrthopedic Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ocean Park Orthopedic and Sports Therapy Orthopedic Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582329600000",
    "number": "1962432765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1204 N INGLEWOOD ST",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222052461",
            "telephone_number": "703-622-0603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7900 WESTPARK DR STE A30",
            "city": "MC LEAN",
            "state": "VA",
            "postal_code": "221024241",
            "telephone_number": "703-650-8824",
            "fax_number": "703-848-0889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SO",
        "first_name": "JAMIE",
        "middle_name": "M",
        "name_prefix": "Miss",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-04",
        "last_updated": "2020-02-22",
        "certification_date": "2020-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "VA",
            "license": "2305203639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in MC Lean, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2020; 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.