Active NPI
Jamie M So, DPT
- Orthopedic Physical Therapist
- MC Lean, VA
National Provider Identifier
1962432765
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopedic Physical Therapist
- License
- 2305203639
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| License | State | Type | Specialty |
|---|---|---|---|
| 2305203639 | VA | MD | Orthopedic Physical Therapist |
Practice roles
| Organization | Specialty | Status | New 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.