Provider Demographics
NPI:1831481118
Name:HESS, JENNY NICOLE (PTA)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:NICOLE
Last Name:HESS
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 1:1024 SMITHSON AVE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16511-1978
Mailing Address - Country:US
Mailing Address - Phone:814-450-4328
Mailing Address - Fax:
Practice Address - Street 1:1024 SMITHSON AVE
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16511-1978
Practice Address - Country:US
Practice Address - Phone:814-450-4328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI002869225200000X
2471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography