Provider Demographics
NPI:1417484593
Name:THOMAS, JESSICA M (DPT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:THOMAS
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 1:813 BOARDMAN POLAND RD STE 12B
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5104
Mailing Address - Country:US
Mailing Address - Phone:330-729-9448
Mailing Address - Fax:330-729-9450
Practice Address - Street 1:813 BOARDMAN POLAND RD STE 12B
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5104
Practice Address - Country:US
Practice Address - Phone:330-729-9448
Practice Address - Fax:330-729-9450
Is Sole Proprietor?:No
Enumeration Date:2017-05-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT016859225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist