Provider Demographics
NPI:1619537107
Name:HON, JENESSA MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:JENESSA
Middle Name:MARIE
Last Name:HON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 E UNIVERSITY DR UNIT 175
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-8343
Mailing Address - Country:US
Mailing Address - Phone:480-436-9548
Mailing Address - Fax:
Practice Address - Street 1:4015 S ARIZONA AVE STE 2
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-4586
Practice Address - Country:US
Practice Address - Phone:480-426-8019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPTA-013783225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant