Provider Demographics
NPI:1174827422
Name:PYBUS, JESSICA GRACE (LPTA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:GRACE
Last Name:PYBUS
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 TELLURIDE LN
Mailing Address - Street 2:
Mailing Address - City:MIDLAND CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36350-7037
Mailing Address - Country:US
Mailing Address - Phone:334-791-9196
Mailing Address - Fax:
Practice Address - Street 1:5500 CHAMBLEE DUNWOODY RD STE 5B
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-4162
Practice Address - Country:US
Practice Address - Phone:770-396-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-30
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA5564225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant