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NPI Code Detail

MEDICARE: JENNIFER REASOR DPT

MEDICARE: JENNIFER REASOR DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist2305205074VA

General Provider Information

NPI Number : 1609235993
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER REASOR DPT
Provider Business Mailing Address
First Line : 4871 COVENTRY LN
Second Line :
City : NORFOLK
State : VA
Zip : 23518-1636
Country : US
Telephone Number : 540-761-3496
Fax Number :
Provider Business Practice Location Address
First Line : 1628 OLD DONATION PKWY
Second Line : REHABILITATION DEPARTMENT
City : VIRGINIA BEACH
State : VA
Zip : 23454-3062
Country : US
Telephone Number : 757-325-9960
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2016
Last Update Date : 02/16/2016

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