Provider Demographics
NPI:1083909196
Name:LLOYD, JONATHAN M (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:M
Last Name:LLOYD
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:771 PILOT HOUSE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-1990
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:100 WINTERS ST
Practice Address - Street 2:SUITE 106
Practice Address - City:WEST POINT
Practice Address - State:VA
Practice Address - Zip Code:23181-9534
Practice Address - Country:US
Practice Address - Phone:804-843-9033
Practice Address - Fax:804-843-9037
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2305210534225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05954OtherGROUP MEDICARE PTAN
VA1083909196OtherMEDICAID QMB PROVIDER ID
VAC05954OtherGROUP MEDICARE PTAN