Provider Demographics
NPI:1881982957
Name:DURR, JESSICA A (DPT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:DURR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:THORPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:13537 BARRETT PARKWAY DR
Mailing Address - Street 2:BALLWIN
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-5899
Mailing Address - Country:US
Mailing Address - Phone:314-821-9126
Mailing Address - Fax:314-821-9142
Practice Address - Street 1:5300 N ILLINOIS ST
Practice Address - Street 2:FAIRVIEW HEIGHTS
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-3500
Practice Address - Country:US
Practice Address - Phone:618-624-9300
Practice Address - Fax:618-624-9330
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070018507225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL532400014Medicare PIN