Provider Demographics
NPI:1942361407
Name:RICHARD, JESSICA ROTHWELL (MS, PT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ROTHWELL
Last Name:RICHARD
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ROTHWELL
Other - Last Name:HARRIMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:39 SHORE AVE
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-2441
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:76 SHIRLEY AVE
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-5102
Practice Address - Country:US
Practice Address - Phone:781-284-8277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11496225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0322849OtherMASS HEALTH PROVIDER NUMB