Provider Demographics
NPI:1558763649
Name:FURLONG, JESSE DANIEL
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:DANIEL
Last Name:FURLONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5255 ALEXANDER RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:VA
Mailing Address - Zip Code:24084-3657
Mailing Address - Country:US
Mailing Address - Phone:540-307-4249
Mailing Address - Fax:540-674-4094
Practice Address - Street 1:5255 ALEXANDER RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:VA
Practice Address - Zip Code:24084-3657
Practice Address - Country:US
Practice Address - Phone:540-307-4249
Practice Address - Fax:540-674-4094
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208950225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist