Provider Demographics
NPI:1497093371
Name:WHITE, JESSICA JUSTICE (RN, LPTA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JUSTICE
Last Name:WHITE
Suffix:
Gender:F
Credentials:RN, LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9566 KIMBERLY LYNN CIR
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-7328
Mailing Address - Country:US
Mailing Address - Phone:804-564-7732
Mailing Address - Fax:
Practice Address - Street 1:9566 KIMBERLY LYNN CIR
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-7328
Practice Address - Country:US
Practice Address - Phone:804-564-7732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001207651163W00000X
VA2306001312225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No163W00000XNursing Service ProvidersRegistered Nurse