Provider Demographics
NPI:1467747618
Name:ZIEBARTH, JESSICA LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LEE
Last Name:ZIEBARTH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:738 N COLLEGE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3385
Mailing Address - Country:US
Mailing Address - Phone:208-814-7100
Mailing Address - Fax:
Practice Address - Street 1:738 N COLLEGE RD
Practice Address - Street 2:SUITE C
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3385
Practice Address - Country:US
Practice Address - Phone:208-814-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-0880208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation