Provider Demographics
NPI:1114125499
Name:THARP, JESSICA (MS,PT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:THARP
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19384 OUTER BANK RD
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-8121
Mailing Address - Country:US
Mailing Address - Phone:317-774-1143
Mailing Address - Fax:
Practice Address - Street 1:226 S ANDERSON ST
Practice Address - Street 2:SUITE B
Practice Address - City:ELWOOD
Practice Address - State:IN
Practice Address - Zip Code:46036-2015
Practice Address - Country:US
Practice Address - Phone:765-552-8460
Practice Address - Fax:765-552-8470
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008329A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist