Provider Demographics
NPI:1013491547
Name:DIGIACOMO, JESSICA ELIZABETH (DPT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ELIZABETH
Last Name:DIGIACOMO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14100 SE 36TH ST STE 210
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1657
Mailing Address - Country:US
Mailing Address - Phone:425-653-7100
Mailing Address - Fax:425-653-7109
Practice Address - Street 1:14100 SE 36TH ST STE 210
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1657
Practice Address - Country:US
Practice Address - Phone:425-653-7100
Practice Address - Fax:425-653-7109
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPT60876234OtherPT LICENSE