Provider Demographics
NPI:1497984876
Name:AMLING, JESSICA (PT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:AMLING
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 1:230 E 17TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3824
Mailing Address - Country:US
Mailing Address - Phone:949-631-0125
Mailing Address - Fax:714-631-0127
Practice Address - Street 1:230 E 17TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3824
Practice Address - Country:US
Practice Address - Phone:949-631-0125
Practice Address - Fax:714-631-0127
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT35754225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist