Provider Demographics
NPI:1821581257
Name:COFFEY, JESSICA POPE (DPT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:POPE
Last Name:COFFEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 BUTLER PL
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-3710
Mailing Address - Country:US
Mailing Address - Phone:706-250-0081
Mailing Address - Fax:762-320-5338
Practice Address - Street 1:3604 VERANDAH DR STE AANDB
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-5608
Practice Address - Country:US
Practice Address - Phone:706-250-0081
Practice Address - Fax:762-320-5338
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT014071225100000X, 2251E1300X
SC9145225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical