Provider Demographics
NPI:1821461583
Name:SEGURA, JESSICA SHARON (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:SHARON
Last Name:SEGURA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:SHARON
Other - Last Name:DEVINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:314 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WI
Mailing Address - Zip Code:53563-1413
Mailing Address - Country:US
Mailing Address - Phone:608-774-3556
Mailing Address - Fax:
Practice Address - Street 1:314 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WI
Practice Address - Zip Code:53563-1413
Practice Address - Country:US
Practice Address - Phone:608-774-3556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2383-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant