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General NPI Number Information
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NPI Number | 1104375039
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Entity Type | Individual
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Provider Name | JESSICA ROOT DPT
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Gender | Female
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Dates
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Enumeration Date | 10/04/2016
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Last Update Date | 02/20/2020
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Provider Practice Location Address
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Address Line | 300 POLARIS PKWY
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City | WESTERVILLE
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State | OH
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Zip | 43082-7989
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Country | US
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Telephone | 614-776-0970
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Fax | 614-212-4900
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Provider Business Mailing Address
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Address Line | 91 HOWARD AVE UNIT 1
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City | WORTHINGTON
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State | OH
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Zip | 43085-3652
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Country | US
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Telephone | 937-604-7628
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Fax | 614-212-4900
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT017752
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070.022656
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License Number State | IL
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