Provider Demographics
NPI:1023785169
Name:GUTT, JESSICA ANNE (PT)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ANNE
Last Name:GUTT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:LONG VALLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07853-3516
Mailing Address - Country:US
Mailing Address - Phone:908-328-4713
Mailing Address - Fax:
Practice Address - Street 1:197 RIDGEDALE AVE STE 155
Practice Address - Street 2:
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-2198
Practice Address - Country:US
Practice Address - Phone:973-605-5115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA020223200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist