Provider Demographics
NPI:1316999766
Name:PUMPHREY, JERRY ORRISON (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:JERRY
Middle Name:ORRISON
Last Name:PUMPHREY
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 HICKORY PARK DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-2629
Mailing Address - Country:US
Mailing Address - Phone:804-756-8495
Mailing Address - Fax:804-270-7756
Practice Address - Street 1:5300 HICKORY PARK DR
Practice Address - Street 2:SUITE 110
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-2629
Practice Address - Country:US
Practice Address - Phone:804-756-8495
Practice Address - Fax:804-270-7756
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305002651225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1760434948OtherGROUP PRACTICE NPI