Provider Demographics
NPI:1679946537
Name:SCOLA, JESSICA LEIGH
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEIGH
Last Name:SCOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 W WAYNE TER
Mailing Address - Street 2:APT 18C
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-2946
Mailing Address - Country:US
Mailing Address - Phone:856-912-1676
Mailing Address - Fax:
Practice Address - Street 1:208 W WAYNE TER
Practice Address - Street 2:APT 18C
Practice Address - City:COLLINGSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08108-2946
Practice Address - Country:US
Practice Address - Phone:856-912-1676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-01
Last Update Date:2015-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01574400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist