Provider Demographics
NPI:1144576158
Name:WEISEL, JESSICA C (DPT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:C
Last Name:WEISEL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 MERION AVE APT A
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2840
Mailing Address - Country:US
Mailing Address - Phone:215-872-9496
Mailing Address - Fax:
Practice Address - Street 1:3201 CHELTENHAM AVENUE
Practice Address - Street 2:
Practice Address - City:WYNCOTE
Practice Address - State:PA
Practice Address - Zip Code:19095
Practice Address - Country:US
Practice Address - Phone:215-517-7551
Practice Address - Fax:215-517-7549
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
PAPT-022187225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist