Provider Demographics
NPI:1659002228
Name:RALSTON, JESSIE LEE (DPT)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:LEE
Last Name:RALSTON
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:PO BOX 949
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-0949
Mailing Address - Country:US
Mailing Address - Phone:912-638-1444
Mailing Address - Fax:912-638-0077
Practice Address - Street 1:212 RETREAT VLG
Practice Address - Street 2:
Practice Address - City:SAINT SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-2403
Practice Address - Country:US
Practice Address - Phone:912-638-1444
Practice Address - Fax:912-638-0077
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACP017798T225100000X
OK6225225100000X
FLPT40235225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist