Healthcare Provider Details

I. General information

NPI: 1124154471
Provider Name (Legal Business Name): WENDY B JAFFE, PT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 INLYNNVIEW RD
VIRGINIA BEACH VA
23454-1846
US

IV. Provider business mailing address

2525 INLYNNVIEW RD
VIRGINIA BEACH VA
23454-1846
US

V. Phone/Fax

Practice location:
  • Phone: 757-268-2604
  • Fax:
Mailing address:
  • Phone: 757-268-2604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2305005698
License Number StateVA

VIII. Authorized Official

Name: WENDY B JAFFE
Title or Position: OWNER
Credential:
Phone: 757-268-2604