Provider Demographics
NPI:1841784337
Name:MEYER, JESSICA DORNAK (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:DORNAK
Last Name:MEYER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LEIGH
Other - Last Name:DORNAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:PO BOX 14
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77470-0014
Mailing Address - Country:US
Mailing Address - Phone:979-541-7519
Mailing Address - Fax:
Practice Address - Street 1:825 W FAIRWINDS ST
Practice Address - Street 2:
Practice Address - City:HALLETTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77964-3531
Practice Address - Country:US
Practice Address - Phone:361-798-3268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2089787225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant