Healthcare Provider Details

I. General information

NPI: 1013453026
Provider Name (Legal Business Name): JESSICA VODZAK PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA DANIELLE LEWIS

II. Dates (important events)

Enumeration Date: 01/13/2017
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CLEAVER FARM RD
MIDDLETOWN DE
19709-1630
US

IV. Provider business mailing address

200 CLEAVER FARM RD
MIDDLETOWN DE
19709-1630
US

V. Phone/Fax

Practice location:
  • Phone: 302-449-2048
  • Fax:
Mailing address:
  • Phone: 302-449-2048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0003635
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: