Provider Demographics
NPI:1427561521
Name:NEWCOMER, JESSICA ANN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:NEWCOMER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:STOLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:630-928-5080
Practice Address - Street 1:4026F ELKHART RD
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-5795
Practice Address - Country:US
Practice Address - Phone:574-501-3222
Practice Address - Fax:574-346-0169
Is Sole Proprietor?:No
Enumeration Date:2017-11-10
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT013354225100000X
ALPTH8812225100000X
MO2017043057225100000X
FLPT33173225100000X
IN05013172A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist