Provider Demographics
NPI:1376608760
Name:MILLER, JESSA SUSAN (PT)
Entity Type:Individual
Prefix:
First Name:JESSA
Middle Name:SUSAN
Last Name:MILLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JESSA
Other - Middle Name:SUSAN
Other - Last Name:HODGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 41
Mailing Address - Street 2:3931 COTTAGE BRIDGE RD
Mailing Address - City:SCIO
Mailing Address - State:NY
Mailing Address - Zip Code:14880
Mailing Address - Country:US
Mailing Address - Phone:585-593-0283
Mailing Address - Fax:
Practice Address - Street 1:240 OCONNOR ST
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895-1055
Practice Address - Country:US
Practice Address - Phone:585-593-5700
Practice Address - Fax:585-593-4529
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0215191225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist