Provider Demographics
NPI:1669697298
Name:STELLACI, JESSICA ANN (DPT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:STELLACI
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 1:12619 ROCKROSE GLN
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-2835
Mailing Address - Country:US
Mailing Address - Phone:941-722-3582
Mailing Address - Fax:941-729-8322
Practice Address - Street 1:THE KIDSPOT 410 10TH AVE W.
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221
Practice Address - Country:US
Practice Address - Phone:941-722-3582
Practice Address - Fax:941-729-8322
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23081225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist