Provider Demographics
NPI:1275965626
Name:CLEMENTS, JESSICA ISACSON
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ISACSON
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MICHELE
Other - Last Name:ISACSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5589 OKEECHOBEE BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-4486
Mailing Address - Country:US
Mailing Address - Phone:561-613-3037
Mailing Address - Fax:
Practice Address - Street 1:5589 OKEECHOBEE BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-4486
Practice Address - Country:US
Practice Address - Phone:561-613-3037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH 6911225100000X
FLPT32493225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist