Healthcare Provider Details

I. General information

NPI: 1518292804
Provider Name (Legal Business Name): JESSICA SHIPE P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2009
Last Update Date: 10/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 MAIN ST
WINTERSVILLE OH
43953-3733
US

IV. Provider business mailing address

110 MAIN ST
WINTERSVILLE OH
43953-3734
US

V. Phone/Fax

Practice location:
  • Phone: 740-266-6855
  • Fax: 740-264-4376
Mailing address:
  • Phone: 740-266-4908
  • Fax: 740-264-4376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPENDING
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: