Provider Demographics
NPI:1629188115
Name:TITUS, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:TITUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 W CHANDLER BLVD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-2506
Mailing Address - Country:US
Mailing Address - Phone:508-561-5281
Mailing Address - Fax:
Practice Address - Street 1:6553 E BAYWOOD AVE
Practice Address - Street 2:STE 205
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1752
Practice Address - Country:US
Practice Address - Phone:480-396-9922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7274OtherLICENSE #