Provider Demographics
NPI:1235189945
Name:JESSEN, ROBERT MANUEL (PT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MANUEL
Last Name:JESSEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 JONAH DR
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NC
Mailing Address - Zip Code:27299-9175
Mailing Address - Country:US
Mailing Address - Phone:336-752-4017
Mailing Address - Fax:336-243-4014
Practice Address - Street 1:1201 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-2835
Practice Address - Country:US
Practice Address - Phone:336-243-2702
Practice Address - Fax:336-243-4014
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9435225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCH346512Medicare ID - Type Unspecified
NC7211466Medicare ID - Type Unspecified