Provider Demographics
NPI:1295851715
Name:SUOMALA, JESSICA A (PT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:SUOMALA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WAKELEE AVE
Mailing Address - Street 2:
Mailing Address - City:ANSONIA
Mailing Address - State:CT
Mailing Address - Zip Code:06401-1151
Mailing Address - Country:US
Mailing Address - Phone:203-734-7900
Mailing Address - Fax:203-734-0396
Practice Address - Street 1:144 OXFORD RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:CT
Practice Address - Zip Code:06478-1982
Practice Address - Country:US
Practice Address - Phone:203-881-5266
Practice Address - Fax:203-881-5264
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006908225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist