Provider Demographics
NPI:1356710735
Name:SINGH, JAGDEEP
Entity type:Individual
Prefix:
First Name:JAGDEEP
Middle Name:
Last Name:SINGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 EASTOVER DR APT H
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-2941
Mailing Address - Country:US
Mailing Address - Phone:586-219-7872
Mailing Address - Fax:
Practice Address - Street 1:503 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CHASE CITY
Practice Address - State:VA
Practice Address - Zip Code:23924-1407
Practice Address - Country:US
Practice Address - Phone:434-533-3367
Practice Address - Fax:434-830-0566
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206212225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist