Provider Demographics
NPI:1740737030
Name:RAMOS, JESSICA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:RAMOS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 15TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4709
Mailing Address - Country:US
Mailing Address - Phone:917-620-9571
Mailing Address - Fax:
Practice Address - Street 1:27 GAULDY AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-7204
Practice Address - Country:US
Practice Address - Phone:917-620-9571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-05
Last Update Date:2016-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040750225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist