Provider Demographics
NPI:1659143055
Name:WITHERSPOON, JERCORA (PTA)
Entity Type:Individual
Prefix:
First Name:JERCORA
Middle Name:
Last Name:WITHERSPOON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W 1ST ST APT B2
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-1139
Mailing Address - Country:US
Mailing Address - Phone:570-912-3371
Mailing Address - Fax:
Practice Address - Street 1:541 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:SHAMOKIN
Practice Address - State:PA
Practice Address - Zip Code:17872-6754
Practice Address - Country:US
Practice Address - Phone:570-644-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant