Provider Demographics
NPI:1639571581
Name:PERRY, JESSICA (DPT)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3680 PLEASANT HILL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-3268
Mailing Address - Country:US
Mailing Address - Phone:770-813-5575
Mailing Address - Fax:770-813-0032
Practice Address - Street 1:1225 KNOX AVE UNIT 100
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-4022
Practice Address - Country:US
Practice Address - Phone:843-800-8345
Practice Address - Fax:843-800-8346
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPP011648225100000X
SC8415225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty