Provider Demographics
NPI:1093838328
Name:HARTZELL, JESSICA ANNE (MSPT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:HARTZELL
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:KOSTYU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:40 DUKE MEDICINE CLINIC- DEPT OF REHABILITATION SERVICE
Mailing Address - Street 2:BOX 3965
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27710
Mailing Address - Country:US
Mailing Address - Phone:919-684-2088
Mailing Address - Fax:919-668-3131
Practice Address - Street 1:40 DUKE MEDICINE CIR
Practice Address - Street 2:DEPARTMENT OF REHABILIATION SERVICES
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-4000
Practice Address - Country:US
Practice Address - Phone:919-684-2088
Practice Address - Fax:919-668-3131
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6836225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1108GOtherBCBS
NC2508393Medicare ID - Type Unspecified