Provider Demographics
NPI:1487850608
Name:MONTELEONE, JESSICA G (PT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:G
Last Name:MONTELEONE
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 1:2323 W MAIN ST
Mailing Address - Street 2:STE 109
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-1287
Mailing Address - Country:US
Mailing Address - Phone:850-835-6838
Mailing Address - Fax:
Practice Address - Street 1:2323 W MAIN ST STE 109
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-1287
Practice Address - Country:US
Practice Address - Phone:850-267-9010
Practice Address - Fax:850-267-0677
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH8878225100000X
FLPT3883225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7446067OtherJESS'S AETNA PROVIDER#