Basic Information
| Provider Information | |||||||||
| NPI: | 1457649741 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VOLTIN | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | T. | ||||||||
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| Credential: | PT, DPT, CERT. MDT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 69030 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212649030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578732302 | ||||||||
| FaxNumber: | 7578732306 | ||||||||
| Practice Location | |||||||||
| Address1: | 7151 RICHMOND RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 231887234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573450753 | ||||||||
| FaxNumber: | 7573452892 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2011 | ||||||||
| LastUpdateDate: | 05/04/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305206972 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1457649741 | 01 | VA | MEDICAID QMB PROVIDER ID | OTHER | 192935 | 01 | VA | BCBS (PHYSICAL THERAPY) | OTHER | P01102040 | 01 | VA | MEDICARE RR PTAN | OTHER |