Provider Demographics
NPI:1487668547
Name:BEECH, JESSICA LYNN WALTER (PT, DPT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNN WALTER
Last Name:BEECH
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:WALTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, ATC
Mailing Address - Street 1:8551 RIXLEW LN STE 340
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-4278
Mailing Address - Country:US
Mailing Address - Phone:703-368-7343
Mailing Address - Fax:703-368-0719
Practice Address - Street 1:8551 RIXLEW LN STE 340
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-4278
Practice Address - Country:US
Practice Address - Phone:703-368-7343
Practice Address - Fax:703-368-0719
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203810225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAQ02356Medicare UPIN
VA003540D29Medicare ID - Type Unspecified