Provider Demographics
NPI:1679308860
Name:WARR, JESSILYN PATRICIA (LPTA)
Entity type:Individual
Prefix:
First Name:JESSILYN
Middle Name:PATRICIA
Last Name:WARR
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:JESSILYN
Other - Middle Name:PATRICIA
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 GRAYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:DALEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24083-2940
Mailing Address - Country:US
Mailing Address - Phone:540-761-6342
Mailing Address - Fax:
Practice Address - Street 1:4435 PHEASANT RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-5285
Practice Address - Country:US
Practice Address - Phone:540-725-1120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306606264225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant