Provider Demographics
NPI:1770957029
Name:VIRGADAMO, JESSICA (DPT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:VIRGADAMO
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 1:175 W LOWRY LN
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3012
Mailing Address - Country:US
Mailing Address - Phone:859-475-4305
Mailing Address - Fax:
Practice Address - Street 1:175 W LOWRY LN
Practice Address - Street 2:SUITE 104
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3012
Practice Address - Country:US
Practice Address - Phone:859-475-4305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0065552251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics