Provider Demographics
NPI:1164657110
Name:JESSUM, KAREN (PT, PHD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:JESSUM
Suffix:
Gender:F
Credentials:PT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 57413
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91413-2413
Mailing Address - Country:US
Mailing Address - Phone:818-454-5846
Mailing Address - Fax:
Practice Address - Street 1:4610 KESTER AVE APT 20
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2527
Practice Address - Country:US
Practice Address - Phone:818-454-5846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT1633225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist