Provider Demographics
NPI:1255646295
Name:EDWARDS, JESSICA (PT, DPT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:EDWARDS
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 1:711 E PALM AVE APT C
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-2142
Mailing Address - Country:US
Mailing Address - Phone:323-430-7954
Mailing Address - Fax:
Practice Address - Street 1:711 E PALM AVE APT C
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91501
Practice Address - Country:US
Practice Address - Phone:323-430-7954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-14
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 32557225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist