Provider Demographics
NPI:1114495819
Name:HOLCOMB, JESSECA (MS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:JESSECA
Middle Name:
Last Name:HOLCOMB
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 N PARKWAY
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-1624
Mailing Address - Country:US
Mailing Address - Phone:901-843-3276
Mailing Address - Fax:901-843-3749
Practice Address - Street 1:2000 N PARKWAY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-1624
Practice Address - Country:US
Practice Address - Phone:901-843-3276
Practice Address - Fax:901-843-3749
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000013892081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine