Provider Demographics
NPI:1801384706
Name:WORLEY, JESSICA ANN (PTA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:WORLEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 ROSEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-6021
Mailing Address - Country:US
Mailing Address - Phone:903-305-6321
Mailing Address - Fax:
Practice Address - Street 1:409 ROSEWOOD ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-6021
Practice Address - Country:US
Practice Address - Phone:903-305-6321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2087546225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant