Provider Demographics
NPI:1184399370
Name:MANSON, JESSICA LYNNE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNNE
Last Name:MANSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9118 BRIXHAM DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-8333
Mailing Address - Country:US
Mailing Address - Phone:845-863-4841
Mailing Address - Fax:
Practice Address - Street 1:710 FM 359 RD S
Practice Address - Street 2:
Practice Address - City:BROOKSHIRE
Practice Address - State:TX
Practice Address - Zip Code:77423-9510
Practice Address - Country:US
Practice Address - Phone:845-863-4841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2143669225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant