Healthcare Provider Details

I. General information

NPI: 1427969716
Provider Name (Legal Business Name): DR. JAKEVIOUS DEWAYNE ROSSER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 N GLEBE RD STE 410
ARLINGTON VA
22201-5931
US

IV. Provider business mailing address

5975 GRAND PAVILION WAY UNIT 214
ALEXANDRIA VA
22303-2297
US

V. Phone/Fax

Practice location:
  • Phone: 571-414-6930
  • Fax:
Mailing address:
  • Phone: 731-734-9392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305217932
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: