Provider Demographics
NPI:1003202953
Name:PETTIT, JESSICA BROOKE (DPT, PT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:BROOKE
Last Name:PETTIT
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26049 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39773-2760
Mailing Address - Country:US
Mailing Address - Phone:662-391-4000
Mailing Address - Fax:662-391-4002
Practice Address - Street 1:26049 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773-2760
Practice Address - Country:US
Practice Address - Phone:662-391-4000
Practice Address - Fax:662-391-4002
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT4882225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist