Provider Demographics
NPI:1619238813
Name:DAVIES, JESSICA LYNN (PT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNN
Last Name:DAVIES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:1177 QUAIL CT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-3790
Mailing Address - Country:US
Mailing Address - Phone:262-695-3057
Mailing Address - Fax:262-695-3063
Practice Address - Street 1:807 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-8150
Practice Address - Country:US
Practice Address - Phone:414-224-8219
Practice Address - Fax:414-224-8246
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI5491-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist