Provider Demographics
NPI:1124154471
Name:WENDY B JAFFE, PT, PLLC
Entity type:Organization
Organization Name:WENDY B JAFFE, PT, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:B
Authorized Official - Last Name:JAFFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-268-2604
Mailing Address - Street 1:2525 INLYNNVIEW RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-1846
Mailing Address - Country:US
Mailing Address - Phone:757-268-2604
Mailing Address - Fax:
Practice Address - Street 1:2525 INLYNNVIEW RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-1846
Practice Address - Country:US
Practice Address - Phone:757-268-2604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23050056982251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA195322OtherSOUTHEAST SERVICES, INC.
VA452542OtherANTHEM BC BS