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NPI Code Detail

MEDICARE: WENDY B JAFFE PT

MEDICARE: WENDY B JAFFE PT
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
12251P0200XPediatric Physical Therapist2305005698VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1452542OTHERVAANTHEM BC BS

General Provider Information

NPI Number : 1699866376
Entity Type Code : Individual
Provider Name (Legal Business Name) : WENDY B JAFFE PT
Provider Business Mailing Address
First Line : 928 DIAMOND SPRINGS RD STE 103
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23455-6601
Country : US
Telephone Number : 757-395-1975
Fax Number : 757-425-7180
Provider Business Practice Location Address
First Line : 928 DIAMOND SPRINGS RD STE 103
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23455-6601
Country : US
Telephone Number : 757-395-1975
Fax Number : 757-425-7180
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2006
Last Update Date : 04/22/2022

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