Provider Demographics
NPI:1285009969
Name:BETTIN, JESSICA (DPT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BETTIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HOLSTEIN
Mailing Address - State:IA
Mailing Address - Zip Code:51025-5111
Mailing Address - Country:US
Mailing Address - Phone:712-368-4304
Mailing Address - Fax:
Practice Address - Street 1:505 W 2ND ST
Practice Address - Street 2:
Practice Address - City:HOLSTEIN
Practice Address - State:IA
Practice Address - Zip Code:51025-5111
Practice Address - Country:US
Practice Address - Phone:712-368-4304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA005323225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist