Provider Demographics
NPI:1477678340
Name:RICHARDSON, JOANNE JERUSHA (PTA)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:JERUSHA
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:JOANNE
Other - Middle Name:RICHARDSON
Other - Last Name:JABER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:18308 MARQUIS ROAD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:VA
Mailing Address - Zip Code:22960
Mailing Address - Country:US
Mailing Address - Phone:540-854-4361
Mailing Address - Fax:
Practice Address - Street 1:18308 MARQUIS RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:VA
Practice Address - Zip Code:22960-3334
Practice Address - Country:US
Practice Address - Phone:540-854-4361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306000888225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant