Provider Demographics
NPI:1932471737
Name:TATE, JESSICA KEELER (DPT, OCS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:KEELER
Last Name:TATE
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Gender:F
Credentials:DPT, OCS
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Other - First Name:
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Mailing Address - Street 1:20940 N TATUM BLVD
Mailing Address - Street 2:SUITE B-200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-4265
Mailing Address - Country:US
Mailing Address - Phone:602-483-1710
Mailing Address - Fax:480-272-7793
Practice Address - Street 1:20830 N TATUM BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-7256
Practice Address - Country:US
Practice Address - Phone:480-473-1200
Practice Address - Fax:480-473-1250
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2015-10-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA386292251X0800X
AZ102152251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic