Provider Demographics
NPI:1750509758
Name:LODDER, JESSICA L (PT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:LODDER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:VOORHIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 CHARLES AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-3317
Mailing Address - Country:US
Mailing Address - Phone:309-269-3323
Mailing Address - Fax:714-495-3273
Practice Address - Street 1:1860 EL CAMINO REAL
Practice Address - Street 2:SUITE 201
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3127
Practice Address - Country:US
Practice Address - Phone:650-259-8009
Practice Address - Fax:650-259-9769
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP932Medicare PIN
CAZZZ06873ZMedicare PIN
CAGM053YMedicare PIN
CAGM053ZMedicare PIN