Provider Demographics
NPI:1508521881
Name:LEA, JESSICA (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:LEA
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3118 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-2503
Mailing Address - Country:US
Mailing Address - Phone:915-703-6380
Mailing Address - Fax:915-703-6382
Practice Address - Street 1:3118 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-2503
Practice Address - Country:US
Practice Address - Phone:915-703-6380
Practice Address - Fax:915-703-6382
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1103604225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist