Healthcare Provider Details

I. General information

NPI: 1790352961
Provider Name (Legal Business Name): JESSICA PASQUARIELLO PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 HAND AVE STE Q
ORMOND BEACH FL
32174-8196
US

IV. Provider business mailing address

1400 HAND AVE STE Q
ORMOND BEACH FL
32174-8196
US

V. Phone/Fax

Practice location:
  • Phone: 386-673-9880
  • Fax: 386-673-5841
Mailing address:
  • Phone: 386-673-9880
  • Fax: 386-673-5841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number24962
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT44362
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: