Provider Demographics
NPI:1619211570
Name:JOHNSON, JESSICA FRANCES (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:FRANCES
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:FRANCES
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:118 AUSTON WOODS CIR
Mailing Address - Street 2:APT. M
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-4402
Mailing Address - Country:US
Mailing Address - Phone:864-680-5714
Mailing Address - Fax:
Practice Address - Street 1:515 BENTON ST
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672-6883
Practice Address - Country:US
Practice Address - Phone:864-888-4114
Practice Address - Fax:864-888-4233
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2855225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant