Provider Demographics
NPI:1306153119
Name:CHAISSON, JACINDA BETH (DPT)
Entity type:Individual
Prefix:
First Name:JACINDA
Middle Name:BETH
Last Name:CHAISSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13700 ST. FRANCIS BLVD.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114
Mailing Address - Country:US
Mailing Address - Phone:804-379-9086
Mailing Address - Fax:804-379-1283
Practice Address - Street 1:13700 ST. FRANCIS BLVD.
Practice Address - Street 2:SUITE 103
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114
Practice Address - Country:US
Practice Address - Phone:804-379-9086
Practice Address - Fax:804-379-1283
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206586225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist