Provider Demographics
NPI:1508397944
Name:LLOP, JESSE
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:LLOP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6095 W 18TH AVE APT S220
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-6159
Mailing Address - Country:US
Mailing Address - Phone:786-343-6060
Mailing Address - Fax:
Practice Address - Street 1:6095 W 18TH AVE APT S220
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-6159
Practice Address - Country:US
Practice Address - Phone:786-343-6060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA26281225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant