Provider Demographics
NPI:1417478785
Name:MARN, JESSICA LEIGH CORT (PT)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LEIGH CORT
Last Name:MARN
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 1:11 POTTER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-5121
Mailing Address - Country:US
Mailing Address - Phone:802-233-5615
Mailing Address - Fax:
Practice Address - Street 1:98 STARR FARM RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05408-1323
Practice Address - Country:US
Practice Address - Phone:802-658-6717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0067972225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty