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General NPI Number Information
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NPI Number | 1679308860
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Entity Type | Individual
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Provider Name | JESSILYN PATRICIA WARR LPTA
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Gender | Female
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Dates
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Enumeration Date | 09/05/2024
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 4435 PHEASANT RIDGE RD
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City | ROANOKE
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State | VA
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Zip | 24014-5285
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Country | US
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Telephone | 540-725-1120
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Fax |
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Provider Business Mailing Address
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Address Line | 50 GRAYSTONE DR
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City | DALEVILLE
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State | VA
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Zip | 24083-2940
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Country | US
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Telephone | 540-761-6342
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2306606264
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License Number State | VA
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