Provider Demographics
NPI:1538315163
Name:JESSUP, JASON CHRISTOPHER (PT, MS)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:CHRISTOPHER
Last Name:JESSUP
Suffix:
Gender:M
Credentials:PT, MS
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Mailing Address - Street 1:2318 SAN JACINTO BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-7535
Mailing Address - Country:US
Mailing Address - Phone:940-380-9111
Mailing Address - Fax:940-380-9112
Practice Address - Street 1:2318 SAN JACINTO BLVD STE 108
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-7535
Practice Address - Country:US
Practice Address - Phone:940-380-9111
Practice Address - Fax:940-380-9112
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11829692251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic