Provider Demographics
NPI:1174821144
Name:MCCARTAN, JESSICA L (PT, DPT, CLT)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:L
Last Name:MCCARTAN
Suffix:
Gender:F
Credentials:PT, DPT, CLT
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:DEVORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, CLT
Mailing Address - Street 1:690 W 2ND ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-5312
Mailing Address - Country:US
Mailing Address - Phone:775-747-2278
Mailing Address - Fax:
Practice Address - Street 1:1514 12TH ST STE 103
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7448
Practice Address - Country:US
Practice Address - Phone:360-752-2673
Practice Address - Fax:360-752-0271
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3079225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist