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General NPI Number Information
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NPI Number | 1356256895
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Entity Type | Individual
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Provider Name | JESSICA WOODS RAFFERTY PTA
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Gender | Female
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Dates
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Enumeration Date | 08/18/2026
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Last Update Date | 08/18/2026
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Provider Practice Location Address
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Address Line | 812 EMERALD BAY RD
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-6413
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Country | US
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Telephone | 530-542-2662
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Fax | 530-542-2661
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Provider Business Mailing Address
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Address Line | 1515 ORMSBY DR
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-7453
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Country | US
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Telephone |
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Fax | 760-264-4342
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 48498
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License Number State | CA
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