Provider Demographics
NPI:1790915940
Name:CARTER, JESSICA LAUREN (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LAUREN
Last Name:CARTER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:LAUREN
Other - Last Name:HUBBAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21 ESSEX WAY
Mailing Address - Street 2:SUITE 116
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-3385
Mailing Address - Country:US
Mailing Address - Phone:802-879-8300
Mailing Address - Fax:802-879-9300
Practice Address - Street 1:21 ESSEX WAY
Practice Address - Street 2:SUITE 116
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-3385
Practice Address - Country:US
Practice Address - Phone:802-879-8300
Practice Address - Fax:802-879-9300
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400047331225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist