Provider Demographics
NPI:1669898169
Name:POPE, JESSICA LYNN (MS, ATC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:POPE
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14819 COURTLANDT HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-3149
Mailing Address - Country:US
Mailing Address - Phone:703-861-4310
Mailing Address - Fax:
Practice Address - Street 1:125 MICHIGAN AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-1004
Practice Address - Country:US
Practice Address - Phone:202-884-9096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20000007982255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000000798OtherBOC