Provider Demographics
NPI:1912414871
Name:TOTH, JESSICA LAUREN
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LAUREN
Last Name:TOTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2878 S ABINGDON ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-1317
Mailing Address - Country:US
Mailing Address - Phone:708-362-0275
Mailing Address - Fax:
Practice Address - Street 1:2878 S ABINGDON ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-1317
Practice Address - Country:US
Practice Address - Phone:708-362-0275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-01
Last Update Date:2018-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305211535225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist