Provider Demographics
NPI:1598066854
Name:PYTYNIA, JESSICA L (LMT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:L
Last Name:PYTYNIA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:1516 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-5524
Mailing Address - Country:US
Mailing Address - Phone:219-221-6118
Mailing Address - Fax:
Practice Address - Street 1:8690 W PAHS RD
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-7666
Practice Address - Country:US
Practice Address - Phone:219-872-5151
Practice Address - Fax:219-872-0177
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT20900373225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist