Provider Demographics
NPI:1639592652
Name:CONIGLIO, JESSA A (PT)
Entity Type:Individual
Prefix:
First Name:JESSA
Middle Name:A
Last Name:CONIGLIO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 OSPREY CT APT 3
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-8868
Mailing Address - Country:US
Mailing Address - Phone:216-513-5950
Mailing Address - Fax:
Practice Address - Street 1:1015 OSPREY CT APT 3
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-8868
Practice Address - Country:US
Practice Address - Phone:216-513-5950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-27
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015892225100000X
OH013456225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist