Provider Demographics
NPI:1891091542
Name:PAUL, JESSICA NICOLE MIGDALSKI (DPT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE MIGDALSKI
Last Name:PAUL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:NICOLE
Other - Last Name:MIGDALSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:4401 S HOPKINS AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-6679
Mailing Address - Country:US
Mailing Address - Phone:321-383-0889
Mailing Address - Fax:
Practice Address - Street 1:4401 S HOPKINS AVE STE 105
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-6679
Practice Address - Country:US
Practice Address - Phone:321-383-0889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-28
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT25635225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist