Provider Demographics
NPI:1275124828
Name:ALLEN, JESSIKA (PT, DPT ATC/L, FAAOM)
Entity Type:Individual
Prefix:DR
First Name:JESSIKA
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PT, DPT ATC/L, FAAOM
Other - Prefix:
Other - First Name:JESSIKA
Other - Middle Name:
Other - Last Name:VOLZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT ATC/L, FAAOM
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:HOOPER
Mailing Address - State:UT
Mailing Address - Zip Code:84315-0066
Mailing Address - Country:US
Mailing Address - Phone:801-827-0200
Mailing Address - Fax:801-827-0201
Practice Address - Street 1:5957 FASHION POINT DR STE 102
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-5180
Practice Address - Country:US
Practice Address - Phone:801-827-0200
Practice Address - Fax:801-827-0201
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11640380-48102255A2300X
UT11640380-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer