Provider Demographics
NPI:1245017706
Name:GARN, JESSE ALEXANDER (PT)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:ALEXANDER
Last Name:GARN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 CHERRY VALLEY TPKE
Mailing Address - Street 2:
Mailing Address - City:MARCELLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13108-9643
Mailing Address - Country:US
Mailing Address - Phone:315-406-1299
Mailing Address - Fax:
Practice Address - Street 1:37 SOUTH ST
Practice Address - Street 2:
Practice Address - City:MARCELLUS
Practice Address - State:NY
Practice Address - Zip Code:13108-1359
Practice Address - Country:US
Practice Address - Phone:315-673-1007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050728225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist