Provider Demographics
NPI:1184746430
Name:SMITH, JESSICA
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:SMITH
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 1:151 S BISHOP AVE
Mailing Address - Street 2:APT. D-15
Mailing Address - City:SECANE
Mailing Address - State:PA
Mailing Address - Zip Code:19018-1971
Mailing Address - Country:US
Mailing Address - Phone:484-461-3921
Mailing Address - Fax:
Practice Address - Street 1:900 LAWRENCE DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-3415
Practice Address - Country:US
Practice Address - Phone:610-696-8090
Practice Address - Fax:610-696-8300
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017130225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist