Healthcare Provider Details

I. General information

NPI: 1619238813
Provider Name (Legal Business Name): JESSICA LYNN DAVIES P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2012
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N 117TH ST
WAUWATOSA WI
53222-4106
US

IV. Provider business mailing address

2900 N 117TH ST
WAUWATOSA WI
53222-4106
US

V. Phone/Fax

Practice location:
  • Phone: 262-375-1075
  • Fax: 262-375-4975
Mailing address:
  • Phone: 262-375-1075
  • Fax: 262-375-4975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5491-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: