Provider Demographics
NPI:1417028200
Name:BARNES, JESSICA ELIZABETH (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ELIZABETH
Last Name:BARNES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:ELIZABETH
Other - Last Name:PETERSHEIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:74 E IRVIN AVE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-3428
Mailing Address - Country:US
Mailing Address - Phone:301-992-7752
Mailing Address - Fax:
Practice Address - Street 1:301 RUSSELL AVE
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2805
Practice Address - Country:US
Practice Address - Phone:301-216-4247
Practice Address - Fax:301-216-4249
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA2359225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant