Healthcare Provider Details

I. General information

NPI: 1174229512
Provider Name (Legal Business Name): MRS. JESSICA CHRISTINE SEHNERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 CARTER ST
RICHMOND HILL GA
31324-3753
US

IV. Provider business mailing address

152 DASHER LN
MIDWAY GA
31320-6301
US

V. Phone/Fax

Practice location:
  • Phone: 912-756-6131
  • Fax:
Mailing address:
  • Phone: 636-236-1314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA004663
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: