Provider Demographics
NPI:1861702060
Name:JENNINGS, MELISSA R (DPT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:R
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:BEHR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2217
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22604-1417
Mailing Address - Country:US
Mailing Address - Phone:540-667-8975
Mailing Address - Fax:540-667-6589
Practice Address - Street 1:130 MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3322
Practice Address - Country:US
Practice Address - Phone:540-667-7076
Practice Address - Fax:540-667-5773
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT002910225100000X
VA2305206713225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2012177027Medicaid
VAQ49465AMedicare PIN
VAVAA104520Medicare PIN