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General NPI Number Information
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NPI Number | 1740484195
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Entity Type | Individual
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Provider Name | THOMAS CHRISTOPHER JESSEE M.S.P.T., C.S.C.S.
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Gender | Male
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 410 S 11TH ST
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City | LAKE WALES
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State | FL
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Zip | 33853-4203
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Country | US
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Telephone | 863-679-6841
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Fax | 863-678-2230
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Provider Business Mailing Address
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Address Line | 728 SANTA MARIA DR
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City | WINTER HAVEN
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State | FL
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Zip | 33884-3805
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Country | US
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Telephone | 863-679-6841
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Fax | 863-678-2230
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT15190
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License Number State | FL
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