Provider Demographics
NPI:1770085581
Name:ANASTOPOULOS, JESSICA BURKHART (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:BURKHART
Last Name:ANASTOPOULOS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4620 JAMES CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-8694
Mailing Address - Country:US
Mailing Address - Phone:336-688-1310
Mailing Address - Fax:
Practice Address - Street 1:801 MEADOWOOD ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409-2838
Practice Address - Country:US
Practice Address - Phone:919-424-5078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP17711225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist