Provider Demographics
NPI:1679087829
Name:HEARY, JESSICA JOY (DPT)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:JOY
Last Name:HEARY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:JOY
Other - Last Name:TOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1518 COFFEE RD STE I
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3164
Mailing Address - Country:US
Mailing Address - Phone:209-576-0888
Mailing Address - Fax:209-576-0913
Practice Address - Street 1:2222 FRANCISCO DR STE 120
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-3763
Practice Address - Country:US
Practice Address - Phone:916-235-4071
Practice Address - Fax:209-222-6182
Is Sole Proprietor?:No
Enumeration Date:2017-11-27
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294034225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist