MEDICARE: JESSICA T. BRISCOE-COLEMAN P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2305202794	VA

General Provider Information

NPI Number	:	1124054523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA T. BRISCOE-COLEMAN P.T.

Provider Business Mailing Address
First Line	:	5275 LEE HWY
Second Line	:	SUITE 200
City	:	ARLINGTON
State	:	VA
Zip	:	22207-1619
Country	:	US
Telephone Number	:	703-532-4892
Fax Number	:	703-237-3105

Provider Business Practice Location Address
First Line	:	5275 LEE HWY
Second Line	:	SUITE 200
City	:	ARLINGTON
State	:	VA
Zip	:	22207-1619
Country	:	US
Telephone Number	:	703-532-4892
Fax Number	:	703-237-3105

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	07/08/2007

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