Provider Demographics
NPI:1316360530
Name:VERDON, JESSICA (DPT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:VERDON
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 1:1329 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IA
Mailing Address - Zip Code:52151-9615
Mailing Address - Country:US
Mailing Address - Phone:563-538-4236
Mailing Address - Fax:
Practice Address - Street 1:1329 MAIN ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IA
Practice Address - Zip Code:52151-9615
Practice Address - Country:US
Practice Address - Phone:563-538-4236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004798225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist