Provider Demographics
NPI:1821498015
Name:DEW, JESSICA HALEY
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:HALEY
Last Name:DEW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 BAYLESS AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39422-9241
Mailing Address - Country:US
Mailing Address - Phone:601-498-5857
Mailing Address - Fax:
Practice Address - Street 1:24 BAYLESS AVE
Practice Address - Street 2:
Practice Address - City:BAY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39422-9241
Practice Address - Country:US
Practice Address - Phone:601-498-5857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPTA5568225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant