Provider Demographics
NPI:1437756053
Name:MARSH, JESSICA L (PTA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:MARSH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:JESICA
Other - Middle Name:L
Other - Last Name:HARTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:158 KLATAWAH ST
Mailing Address - Street 2:
Mailing Address - City:LIBBY
Mailing Address - State:MT
Mailing Address - Zip Code:59923-3235
Mailing Address - Country:US
Mailing Address - Phone:406-293-3860
Mailing Address - Fax:
Practice Address - Street 1:308 E 3RD ST
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-2140
Practice Address - Country:US
Practice Address - Phone:406-293-6285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PTA-LIC-1940225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant