Provider Demographics
NPI:1679956080
Name:JOHNS, JESSICA LYNN (MED, LAT, ATC)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:LYNN
Last Name:JOHNS
Suffix:
Gender:F
Credentials:MED, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 W HORNER ST APT 21
Mailing Address - Street 2:
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-1350
Mailing Address - Country:US
Mailing Address - Phone:412-726-1223
Mailing Address - Fax:
Practice Address - Street 1:117 LAKEVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:LORETTO
Practice Address - State:PA
Practice Address - Zip Code:15940
Practice Address - Country:US
Practice Address - Phone:814-472-3317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0056492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer