Jennifer B. Walle, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2305203320 Issued in VA

Practice address

13801 St Francis Blvd Ste 200
Midlothian, VA 23114

Phone

(804) 320-4604

NPI assigned

Dec 7, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Jennifer L. Bent Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Powhatan Physical Therapy Corporation 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Powhatan Physical Therapy Corporation

  • Physical Therapist
  • Powhatan, VA
  • NPI 1477569200
  Medicare reassignment Care Compare group NPD
• Tidewater Physical Therapy, LLC

  • Physical Therapist
  • Glen Allen, VA
  • NPI 1457389595
  Medicare reassignment NPD
• Well Beyond Physical Therapy

  • Physical Therapist
  • Powhatan, VA
  • NPI 1154271088
  NPD Authorized official
• Tidewater Physical Therapy, LLC

  • Physical Therapist
  • Roanoke, VA
  • NPI 1437664356
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1512604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600300800000",
    "number": "1083129407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 BOULDERS PKWY STE 200",
            "city": "NORTH CHESTERFIELD",
            "state": "VA",
            "postal_code": "232254067",
            "telephone_number": "804-560-5595",
            "fax_number": "804-560-9029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13801 ST FRANCIS BLVD STE 200",
            "city": "MIDLOTHIAN",
            "state": "VA",
            "postal_code": "23114",
            "telephone_number": "804-320-4604"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6049 Harbour Park Dr",
            "address_purpose": "LOCATION",
            "city": "Midlothian",
            "state": "VA",
            "postal_code": "231122160",
            "country_code": "US",
            "telephone_number": "804-639-2359",
            "fax_number": "804-639-2029",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLE",
        "first_name": "JENNIFER",
        "middle_name": "B.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-07",
        "last_updated": "2020-09-17",
        "certification_date": "2020-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305203320",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jwalle25891@direct.orthovirginia.com",
            "affiliation": "N",
            "endpointDescription": "Direct address Dr. Walle",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "secure messaging",
            "address_1": "13801 St Francis Blvd Ste 200",
            "city": "Midlothian",
            "state": "VA",
            "country_code": "US",
            "postal_code": "23114",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "BENT",
            "middle_name": "L.",
            "credential": "PT, DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Tenelle I Walker
• Elizabeth Anne Wallace, MD
• James C Wallace, DDS
• Laurel Slough Wallace, D.O.
• Rochelle Wallace
• Richard Edmund Waller, M.D.
• Timothy Michael Walsh
• Danesha Walters
• Sarah Anne Walters, PT, DPT
• Stephanie Walton

• All providers in Midlothian, VA
• Physical Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.