Provider Demographics
NPI:1326001546
Name:MYERS, JESSICA M (DPT, MPH, CSCS,CMTPT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:M
Last Name:MYERS
Suffix:
Gender:F
Credentials:DPT, MPH, CSCS,CMTPT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MAY
Other - Last Name:ALLISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 69030
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-9030
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:3510 ANDERSON HWY STE 2
Practice Address - Street 2:
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139-5846
Practice Address - Country:US
Practice Address - Phone:804-598-2100
Practice Address - Fax:804-598-7624
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204405225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1326001546Medicaid
VA7966743OtherAETNA
VAP00457792OtherRAILROAD MEDICARE
VA225579OtherBCBS (PHYSICAL THERAPY)
VA016276T54Medicare PIN
VA225579OtherBCBS (PHYSICAL THERAPY)
VA016276T54Medicare PIN