Provider Demographics
NPI:1164049516
Name:TOMKOSKI, JESSICA MARIE RUSSELL (PT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE RUSSELL
Last Name:TOMKOSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MARIE
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5501 WELKIN CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-2023
Mailing Address - Country:US
Mailing Address - Phone:864-752-7464
Mailing Address - Fax:
Practice Address - Street 1:5501 WELKIN CT
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-2023
Practice Address - Country:US
Practice Address - Phone:864-752-7464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP19209225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist