Provider Demographics
NPI:1710232897
Name:DELOACH, JESSICA J (DPT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:J
Last Name:DELOACH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:G
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:20347 TIMBERLAKE RD
Mailing Address - Street 2:STE B
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-7352
Mailing Address - Country:US
Mailing Address - Phone:434-845-9053
Mailing Address - Fax:434-528-2788
Practice Address - Street 1:527 POCKET RD
Practice Address - Street 2:
Practice Address - City:HURT
Practice Address - State:VA
Practice Address - Zip Code:24563-2023
Practice Address - Country:US
Practice Address - Phone:434-845-9053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207516225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist