Provider Demographics
NPI:1477841005
Name:LAI, JESSALIN S (PT)
Entity Type:Individual
Prefix:
First Name:JESSALIN
Middle Name:S
Last Name:LAI
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 1:1325 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-1469
Mailing Address - Country:US
Mailing Address - Phone:814-452-4447
Mailing Address - Fax:814-452-4437
Practice Address - Street 1:1325 W 26TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-1469
Practice Address - Country:US
Practice Address - Phone:814-452-4447
Practice Address - Fax:814-452-4437
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT022015225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist