Provider Demographics
NPI:1295931376
Name:GRANDE, JESSICA N (PT, DPT, CSCS)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:N
Last Name:GRANDE
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16849 CEDAR RUN DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-6977
Mailing Address - Country:US
Mailing Address - Phone:724-991-4718
Mailing Address - Fax:
Practice Address - Street 1:578 OCOEE COMMERCE PKWY
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4219
Practice Address - Country:US
Practice Address - Phone:407-656-6639
Practice Address - Fax:407-656-0921
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT25095225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist