Provider Demographics
NPI:1922310820
Name:CHANEY, JESSICA D (DPT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:D
Last Name:CHANEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:D
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:303 N KEENE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-7193
Mailing Address - Country:US
Mailing Address - Phone:573-443-0225
Mailing Address - Fax:573-443-0290
Practice Address - Street 1:5780 OSAGE BEACH PKWY
Practice Address - Street 2:SUITE 220
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3188
Practice Address - Country:US
Practice Address - Phone:573-693-9128
Practice Address - Fax:573-693-9136
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010022729225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO142430009Medicare PIN