Provider Demographics
NPI:1861004137
Name:JAMES, JESSICA ANDREA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ANDREA
Last Name:JAMES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1372 E LONGVIEW DR APT 15
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-2372
Mailing Address - Country:US
Mailing Address - Phone:202-378-0574
Mailing Address - Fax:
Practice Address - Street 1:1372 E LONGVIEW DR APT 15
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-2372
Practice Address - Country:US
Practice Address - Phone:202-378-0574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019011324225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist