Provider Demographics
NPI:1164585378
Name:PROBST, JESSICA (PT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PROBST
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 19TH ST NW STE 650
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-6119
Mailing Address - Country:US
Mailing Address - Phone:202-803-2068
Mailing Address - Fax:202-846-7629
Practice Address - Street 1:1020 19TH ST NW STE 650
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-6119
Practice Address - Country:US
Practice Address - Phone:202-803-2068
Practice Address - Fax:202-846-7629
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT871023225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist