Provider Demographics
NPI:1457649741
Name:VOLTIN, JESSICA T (PT, DPT, CERT MDT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:T
Last Name:VOLTIN
Suffix:
Gender:F
Credentials:PT, DPT, CERT MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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 1:7151 RICHMOND RD STE 101
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-7234
Practice Address - Country:US
Practice Address - Phone:757-345-0753
Practice Address - Fax:757-345-2892
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206972225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1457649741OtherMEDICAID QMB PROVIDER ID
VA192935OtherBCBS (PHYSICAL THERAPY)
VAP01102040OtherMEDICARE RR PTAN
VAQ37192AMedicare UPIN
VAC05954Medicare PIN