Provider Demographics
NPI:1649473984
Name:YOUNGEN, JENNIFER (PT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:YOUNGEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11818 CLARA WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-1104
Mailing Address - Country:US
Mailing Address - Phone:703-898-3049
Mailing Address - Fax:
Practice Address - Street 1:12642 CHAPEL RD
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:VA
Practice Address - Zip Code:20124-1953
Practice Address - Country:US
Practice Address - Phone:571-563-8976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305006688225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2130582OtherMAMSI
VA196835OtherANTHEM
7727306OtherAETNA
2130582OtherMAMSI