Provider Demographics
NPI:1073540290
Name:MIDKIFF, JESSICA POLLARD (DPT PT)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:POLLARD
Last Name:MIDKIFF
Suffix:
Gender:F
Credentials:DPT PT
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:LYN
Other - Last Name:POLLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT PT
Mailing Address - Street 1:825 E WARNER RD
Mailing Address - Street 2:SUITE C-100
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-0994
Mailing Address - Country:US
Mailing Address - Phone:480-722-0300
Mailing Address - Fax:480-722-0302
Practice Address - Street 1:825 E WARNER RD
Practice Address - Street 2:SUITE C-100
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-0994
Practice Address - Country:US
Practice Address - Phone:480-722-0300
Practice Address - Fax:480-722-0302
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3728225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ72932Medicare ID - Type Unspecified