Provider Demographics
NPI:1225878788
Name:ANGOWSKI, JESSICA LYNN (PT, DPT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:ANGOWSKI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3765 E BLUE LUPINE DR STE E
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-8417
Mailing Address - Country:US
Mailing Address - Phone:907-373-9462
Mailing Address - Fax:907-373-9464
Practice Address - Street 1:3765 E BLUE LUPINE DR STE E
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8417
Practice Address - Country:US
Practice Address - Phone:907-373-9462
Practice Address - Fax:907-373-9464
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2025-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02253100225100000X
AKCP051485T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist