Provider Demographics
NPI:1972898179
Name:HOLDER, JESSICA LYN (DPT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYN
Last Name:HOLDER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:581 CARSON DR
Mailing Address - Street 2:
Mailing Address - City:SPOUT SPRING
Mailing Address - State:VA
Mailing Address - Zip Code:24593-2606
Mailing Address - Country:US
Mailing Address - Phone:434-941-7730
Mailing Address - Fax:
Practice Address - Street 1:581 CARSON DR
Practice Address - Street 2:
Practice Address - City:SPOUT SPRING
Practice Address - State:VA
Practice Address - Zip Code:24593-2606
Practice Address - Country:US
Practice Address - Phone:434-941-7730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205485225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist