Provider Demographics
NPI:1831627835
Name:CAMMARATA, JESSICA LIEB (PT, DPT, NCS)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LIEB
Last Name:CAMMARATA
Suffix:
Gender:F
Credentials:PT, DPT, NCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-3341
Mailing Address - Country:US
Mailing Address - Phone:814-943-3671
Mailing Address - Fax:
Practice Address - Street 1:108 FRANCISCAN WAY
Practice Address - Street 2:
Practice Address - City:LORETTO
Practice Address - State:PA
Practice Address - Zip Code:15940-9703
Practice Address - Country:US
Practice Address - Phone:814-472-3923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-02
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA09857L2251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology