Provider Demographics
NPI:1225593171
Name:GIESEN, JESSICA R (PTA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:GIESEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:R
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1503 WASHINGTON LN
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:KS
Mailing Address - Zip Code:67010-1638
Mailing Address - Country:US
Mailing Address - Phone:316-775-0700
Mailing Address - Fax:316-775-0730
Practice Address - Street 1:1503 WASHINGTON LN
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:KS
Practice Address - Zip Code:67010-1638
Practice Address - Country:US
Practice Address - Phone:316-775-0700
Practice Address - Fax:316-775-0730
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02800225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant