Provider Demographics
NPI:1649423898
Name:PURVIS, JESSICA DAWN (LMT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:DAWN
Last Name:PURVIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 ALDON ST
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-3607
Mailing Address - Country:US
Mailing Address - Phone:360-977-3755
Mailing Address - Fax:
Practice Address - Street 1:1410 ALDON ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-3607
Practice Address - Country:US
Practice Address - Phone:360-977-3755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017753172M00000X
AL6044172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00017753OtherMASSAGE PRACTITIONER
AL6044OtherMASSAGE THERAPIST