Provider Demographics
NPI:1841572328
Name:DEGEAR, JESSICA BLYTHE (PT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:BLYTHE
Last Name:DEGEAR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 CAREY RD
Mailing Address - Street 2:
Mailing Address - City:DE RUYTER
Mailing Address - State:NY
Mailing Address - Zip Code:13052-1262
Mailing Address - Country:US
Mailing Address - Phone:315-852-9614
Mailing Address - Fax:
Practice Address - Street 1:1705 CAREY RD
Practice Address - Street 2:
Practice Address - City:DE RUYTER
Practice Address - State:NY
Practice Address - Zip Code:13052-1262
Practice Address - Country:US
Practice Address - Phone:315-852-9614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021544-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist