Provider Demographics
NPI:1093290074
Name:KATZ, JESSICA BLAIR (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:BLAIR
Last Name:KATZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:B
Other - Last Name:FREEDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1650 LYNDON FARM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5005
Mailing Address - Country:US
Mailing Address - Phone:858-677-4000
Mailing Address - Fax:856-234-3014
Practice Address - Street 1:829 SPRUCE ST STE 105
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5752
Practice Address - Country:US
Practice Address - Phone:215-383-1620
Practice Address - Fax:215-383-1621
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADAPT005066225100000X
PAPT027109225100000X
NJ40QA01823900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist