=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568172419
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA CORKELL DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2022
-----------------------------------------------------
Last Update Date | 10/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 208 N DUPONT BLVD
-----------------------------------------------------
City | SMYRNA
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19977-1511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-653-8389
-----------------------------------------------------
Fax | 302-659-0933
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 208 N DUPONT BLVD
-----------------------------------------------------
City | SMYRNA
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19977-1511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 29220
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | J1-0014865
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------