Provider Demographics
NPI:1477698371
Name:BARRECA, JESSICA A (PT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:BARRECA
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 1:1309 N WELLS ST
Mailing Address - Street 2:#902
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-1970
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1309 N WELLS ST
Practice Address - Street 2:#902
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-1970
Practice Address - Country:US
Practice Address - Phone:773-960-8983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70012645225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist