Provider Demographics
NPI:1477167302
Name:GADBERRY, JESSICA JANE (DPT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JANE
Last Name:GADBERRY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1183 S HWY 837
Mailing Address - Street 2:
Mailing Address - City:NANCY
Mailing Address - State:KY
Mailing Address - Zip Code:42544
Mailing Address - Country:US
Mailing Address - Phone:606-875-0058
Mailing Address - Fax:
Practice Address - Street 1:175 MEDPARK DR
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2734
Practice Address - Country:US
Practice Address - Phone:606-679-1761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP2020043225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist