Provider Demographics
NPI:1598932113
Name:JROSE INTEGRATIVE THERAPY
Entity Type:Organization
Organization Name:JROSE INTEGRATIVE THERAPY
Other - Org Name:JROSE INTEGRATIVE THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:R
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:757-842-6562
Mailing Address - Street 1:900 STANHOPE GARDENS
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320
Mailing Address - Country:US
Mailing Address - Phone:757-842-6562
Mailing Address - Fax:757-842-6563
Practice Address - Street 1:900 STANHOPE GARDENS
Practice Address - Street 2:SUITE 101
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320
Practice Address - Country:US
Practice Address - Phone:757-842-6562
Practice Address - Fax:757-842-6563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202961261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1669426714OtherINDIVIDUAL NPI #
VA1598932113OtherGROUP NPI
GC1012Medicare PIN