Provider Demographics
NPI:1114789815
Name:HARR, JESSICA RUTH
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RUTH
Last Name:HARR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2056 E MIDDLETON DR UNIT 12
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-8616
Mailing Address - Country:US
Mailing Address - Phone:435-272-6852
Mailing Address - Fax:
Practice Address - Street 1:272 E CENTER ST STE 103
Practice Address - Street 2:
Practice Address - City:IVINS
Practice Address - State:UT
Practice Address - Zip Code:84738-6743
Practice Address - Country:US
Practice Address - Phone:435-674-2115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant