Provider Demographics
NPI:1043778434
Name:YIM, JEFFERY LEXING (DPT)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:LEXING
Last Name:YIM
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 REINEKERS LN STE GRV04
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2856
Mailing Address - Country:US
Mailing Address - Phone:703-299-3111
Mailing Address - Fax:703-299-1556
Practice Address - Street 1:225 REINEKERS LN STE GRV04
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2856
Practice Address - Country:US
Practice Address - Phone:703-299-3111
Practice Address - Fax:703-299-1556
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305212617225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist