Provider Demographics
NPI:1821430612
Name:LEVASSEUR, JESSICA ASHLEY (PTA)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:ASHLEY
Last Name:LEVASSEUR
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 1:196 INTERVALE RD
Mailing Address - Street 2:
Mailing Address - City:GILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03249-7432
Mailing Address - Country:US
Mailing Address - Phone:603-293-8236
Mailing Address - Fax:
Practice Address - Street 1:30 COUNTY DR
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-2900
Practice Address - Country:US
Practice Address - Phone:603-527-5410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1119225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant