Provider Demographics
NPI:1942083480
Name:TAINTOR, JESSICA LYNN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:TAINTOR
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:MADDOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:18301 N 79TH AVE
Mailing Address - Street 2:STE B122
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8469
Mailing Address - Country:US
Mailing Address - Phone:623-486-3333
Mailing Address - Fax:623-486-3355
Practice Address - Street 1:18301 N 79TH AVE
Practice Address - Street 2:STE B122
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8469
Practice Address - Country:US
Practice Address - Phone:623-486-3333
Practice Address - Fax:623-486-3355
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-33153225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist