Healthcare Provider Details

I. General information

NPI: 1386465607
Provider Name (Legal Business Name): JYOTHIS JOSEPH MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2024
Last Update Date: 10/19/2024
Certification Date: 10/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1491 VIRGINIA AVE
HARRISONBURG VA
22802-2433
US

IV. Provider business mailing address

891 BLUE RIDGE DR
HARRISONBURG VA
22802-4902
US

V. Phone/Fax

Practice location:
  • Phone: 540-564-3400
  • Fax:
Mailing address:
  • Phone: 479-312-8611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number2305216389
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: