Provider Demographics
NPI:1568974574
Name:JESCHKE, ANNE BUTLER (PT)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:BUTLER
Last Name:JESCHKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:KATHLEEN
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:210 N COMMERCE AVE
Mailing Address - Street 2:
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-4419
Mailing Address - Country:US
Mailing Address - Phone:540-635-5422
Mailing Address - Fax:
Practice Address - Street 1:210 N COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-4419
Practice Address - Country:US
Practice Address - Phone:540-635-5422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305002575225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist