Provider Demographics
NPI:1457908394
Name:TARWATER, JESSICA MARIE (PT,DPT)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:MARIE
Last Name:TARWATER
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MARIE
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT,DPT
Mailing Address - Street 1:20053 SUMMIT VIEW BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601
Mailing Address - Country:US
Mailing Address - Phone:315-681-4187
Mailing Address - Fax:315-661-6068
Practice Address - Street 1:20053 SUMMIT VIEW BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601
Practice Address - Country:US
Practice Address - Phone:315-681-4187
Practice Address - Fax:315-661-6068
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0447631225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist