Provider Demographics
NPI:1528219094
Name:LASSITER, JESSICA LEE (DPT, ATC)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LEE
Last Name:LASSITER
Suffix:
Gender:F
Credentials:DPT, ATC
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Mailing Address - Street 1:423 COURT ST
Mailing Address - Street 2:APT 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-4590
Mailing Address - Country:US
Mailing Address - Phone:347-687-2756
Mailing Address - Fax:
Practice Address - Street 1:3 LAFAYETTE AVE
Practice Address - Street 2:MARK MORRIS WELLNESS CENTER
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1415
Practice Address - Country:US
Practice Address - Phone:347-687-2756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052056052251X0800X
IN36001318A2255A2300X
NY0326612251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer