Healthcare Provider Details

I. General information

NPI: 1699866376
Provider Name (Legal Business Name): WENDY B JAFFE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 DIAMOND SPRINGS RD STE 103
VIRGINIA BEACH VA
23455-6601
US

IV. Provider business mailing address

928 DIAMOND SPRINGS RD STE 103
VIRGINIA BEACH VA
23455-6601
US

V. Phone/Fax

Practice location:
  • Phone: 757-395-1975
  • Fax: 757-425-7180
Mailing address:
  • Phone: 757-395-1975
  • Fax: 757-425-7180

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:
Title or Position:
Credential:
Phone: