Provider Demographics
NPI:1881285286
Name:KOGER, JESSICA DANIELLE (PT, DPT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DANIELLE
Last Name:KOGER
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 392573
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-2415
Mailing Address - Country:US
Mailing Address - Phone:412-339-1063
Mailing Address - Fax:
Practice Address - Street 1:6877 PENN AVE
Practice Address - Street 2:
Practice Address - City:WERNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19565-9611
Practice Address - Country:US
Practice Address - Phone:267-470-1449
Practice Address - Fax:484-334-7450
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT028471225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist