Healthcare Provider Details

I. General information

NPI: 1891588349
Provider Name (Legal Business Name): MRS. JENNIFER MARIE PRESCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 WILLIAMSBURG LANDING DR
WILLIAMSBURG VA
23185-3779
US

IV. Provider business mailing address

11 MOONE CREEK CIR
SMITHFIELD VA
23430-1618
US

V. Phone/Fax

Practice location:
  • Phone: 757-565-6505
  • Fax:
Mailing address:
  • Phone: 757-879-6892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306603513
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: