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General NPI Number Information
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NPI Number | 1821475856
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Entity Type | Individual
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Provider Name | JESSICA RANSOM PTA
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Gender | Female
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Dates
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Enumeration Date | 04/28/2015
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Last Update Date | 04/28/2015
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Provider Practice Location Address
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Address Line | 170 N LA CANADA DR SUITE 20
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City | GREEN VALLEY
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State | AZ
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Zip | 85614-3141
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Country | US
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Telephone | 520-352-3049
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Fax | 520-625-2871
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Provider Business Mailing Address
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Address Line | 170 N LA CANADA DR SUITE 20
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City | GREEN VALLEY
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State | AZ
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Zip | 85614-3141
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Country | US
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Telephone | 520-352-3049
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Fax | 520-625-2871
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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 | 7726A
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License Number State | AZ
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