Provider Demographics
NPI:1710458625
Name:LORD, JESSICA S (DPT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:S
Last Name:LORD
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 1:2321 N 400 E STE 400
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-3425
Mailing Address - Country:US
Mailing Address - Phone:435-833-9070
Mailing Address - Fax:435-243-7375
Practice Address - Street 1:2321 N 400 E STE 400
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-3425
Practice Address - Country:US
Practice Address - Phone:435-833-9070
Practice Address - Fax:435-243-7375
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10712608-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist