Healthcare Provider Details

I. General information

NPI: 1023756376
Provider Name (Legal Business Name): JESSICA LAVINE GOULD DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA ANN LAVINE DPT

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 COLUMBIA PIKE APT 125
ARLINGTON VA
22204-4453
US

IV. Provider business mailing address

2470 MANDEVILLE LN APT 1609
ALEXANDRIA VA
22314-5028
US

V. Phone/Fax

Practice location:
  • Phone: 571-701-2191
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: