Provider Demographics
NPI:1205080298
Name:TIMBERGER, JESSICA (MSPT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:TIMBERGER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 E 56TH ST APT 7J
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-3743
Mailing Address - Country:US
Mailing Address - Phone:212-355-7628
Mailing Address - Fax:
Practice Address - Street 1:345 E 56TH ST APT 7J
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3743
Practice Address - Country:US
Practice Address - Phone:212-355-7628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020897-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics