Individual
JESSICA G BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
10300 COURTHOUSE RD, CHESTERFIELD, VA 23832
(804) 203-1991
Mailing address
8837 CHESTER FOREST LN, NORTH CHESTERFIELD, VA 23237-2655
(804) 338-7667
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
2306603665
VA
Other
Enumeration date
09/17/2019
Last updated
09/17/2019
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