Provider Demographics
NPI:1356765093
Name:DOW, JESICA MACKENZIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:JESICA
Middle Name:MACKENZIE
Last Name:DOW
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:PO BOX 16011
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-6700
Mailing Address - Country:US
Mailing Address - Phone:870-933-9294
Mailing Address - Fax:870-933-9293
Practice Address - Street 1:3114 FOX RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-9322
Practice Address - Country:US
Practice Address - Phone:870-933-9294
Practice Address - Fax:870-933-9293
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist