Provider Demographics
NPI:1134849110
Name:GARRETT, JESSY MATTHEW (PTA)
Entity type:Individual
Prefix:
First Name:JESSY
Middle Name:MATTHEW
Last Name:GARRETT
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MARTIN AVE
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4628
Mailing Address - Country:US
Mailing Address - Phone:207-250-1065
Mailing Address - Fax:
Practice Address - Street 1:95 SKOWHEGAN RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:ME
Practice Address - Zip Code:04937-3479
Practice Address - Country:US
Practice Address - Phone:207-453-1330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA6296225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant