Healthcare Provider Details

I. General information

NPI: 1710126982
Provider Name (Legal Business Name): JESSICA L. STORMER MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1062 SAYBROOK DR
GREENSBURG PA
15601-1155
US

IV. Provider business mailing address

100 ADELLA CT
JEANNETTE PA
15644-4000
US

V. Phone/Fax

Practice location:
  • Phone: 724-853-8466
  • Fax: 724-838-8634
Mailing address:
  • Phone: 724-374-5065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT009135L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: