Provider Demographics
NPI:1205570231
Name:HUANG, JESSICA LAUREN (DPT)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LAUREN
Last Name:HUANG
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 1:5117 DORIN HILL CT
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5536
Mailing Address - Country:US
Mailing Address - Phone:757-817-1003
Mailing Address - Fax:
Practice Address - Street 1:2900 CALCUTT DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2681
Practice Address - Country:US
Practice Address - Phone:804-201-5175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305209546225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist