Basic Information
| Provider Information | |||||||||
| NPI: | 1851770598 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JP THERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5604 VIRGINIA BEACH BLVD STE 101 | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234625631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574555000 | ||||||||
| FaxNumber: | 7573194142 | ||||||||
| Practice Location | |||||||||
| Address1: | 5604 VIRGINIA BEACH BLVD STE 101 | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234625631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574555000 | ||||||||
| FaxNumber: | 7573194142 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2015 | ||||||||
| LastUpdateDate: | 08/02/2022 | ||||||||
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| AuthorizedOfficialLastName: | ADLER | ||||||||
| AuthorizedOfficialFirstName: | JOSHUA | ||||||||
| AuthorizedOfficialMiddleName: | MATTHEW | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7574722513 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | OTR/L | ||||||||
| NPICertificationDate: | 08/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 252Y00000X | N | Agencies | Early Intervention Provider Agency | 225XP0019X | 0119003742 | VA | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation |
No ID Information.