Provider Demographics
NPI:1073512737
Name:HONTIVEROS, JESSICA N (DPT)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:N
Last Name:HONTIVEROS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:N
Other - Last Name:CAPARAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:115 JEFFERSON HWY
Mailing Address - Street 2:LOUISA
Mailing Address - City:LOUISA
Mailing Address - State:VA
Mailing Address - Zip Code:23093-6563
Mailing Address - Country:US
Mailing Address - Phone:540-367-1757
Mailing Address - Fax:540-967-0817
Practice Address - Street 1:16455 E AVENUE OF THE FOUNTAINS
Practice Address - Street 2:FOUNTAIN HILLS
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-8307
Practice Address - Country:US
Practice Address - Phone:480-837-2023
Practice Address - Fax:480-837-2072
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204340225100000X
AZ10614225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist