Healthcare Provider Details

I. General information

NPI: 1750008413
Provider Name (Legal Business Name): JESSICA JAMIESON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 JESSICA LN
WAKEFIELD MA
01880-1252
US

IV. Provider business mailing address

926 MAIN ST
NASHVILLE TN
37206-3614
US

V. Phone/Fax

Practice location:
  • Phone: 617-851-5315
  • Fax: 781-262-3337
Mailing address:
  • Phone: 615-436-9060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number9111
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: