Amanda Mary Jetty, D.P.T

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2305208434 Issued in VA

Practice address

5424 Discovery Park Blvd
BLDG. B /Ste. 101
Williamsburg, VA 23188

Phone

(757) 345-2512

NPI assigned

Jun 16, 2011

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

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tidewater Physicians Multispecialty Group, PCGroup PAC ID 2860398526, 259 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Tidewater Physicians Multispecialty Group PC

  • Family Medicine Physician
  • Newport News, VA
  • NPI 1902848294
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1308182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751500800000",
    "number": "1376838433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "860 OMNI BLVD STE 303",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236064477",
            "telephone_number": "757-232-8769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5424 DISCOVERY PARK BLVD",
            "address_2": "BLDG. B /STE. 101",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "23188",
            "telephone_number": "757-345-2512"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3001 Spring Forest Rd",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276162815",
            "country_code": "US",
            "telephone_number": "704-554-4818",
            "fax_number": "704-551-0659",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3001 Spring Forest Rd",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276162815",
            "country_code": "US",
            "telephone_number": "704-554-4818",
            "fax_number": "704-551-0659",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JETTY",
        "first_name": "AMANDA",
        "middle_name": "MARY",
        "name_prefix": "Miss",
        "credential": "D.P.T",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-16",
        "last_updated": "2025-07-03",
        "certification_date": "2025-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305208434",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julie W Jenkins, N.P.
• Shannon Jenkins, CMT
• Cierra Jennestreet, DC
• Ahyoung Jeon
• Janiah Jerrick
• Ashley Jobe
• Joelle Hairston DDS PLLC
• John H. Speegle and Associates, Inc.
• Aleisha Johnson, MD
• Alex Johnson, LMSW

• Physical Therapist in Williamsburg, VA
• Providers in Williamsburg, VA by specialty
• Physical Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2025; 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.