Healthcare Provider Details

I. General information

NPI: 1740746734
Provider Name (Legal Business Name): JESSICA LEIGHTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2019
Last Update Date: 02/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 TROSKY RD W
EDGERTON MN
56128-2748
US

IV. Provider business mailing address

2901 CHESTER RD SE
EYOTA MN
55934-3703
US

V. Phone/Fax

Practice location:
  • Phone: 507-442-7121
  • Fax:
Mailing address:
  • Phone: 507-696-6556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number094479
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: