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General NPI Number Information
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NPI Number | 1902160427
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Entity Type | Individual
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Provider Name | JESSICA MEHSIKOMER PTA
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Gender | Female
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Dates
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Enumeration Date | 06/29/2012
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Last Update Date | 12/29/2016
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Provider Practice Location Address
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Address Line | 5830 CORAL RIDGE DR STE 300
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City | CORAL SPRINGS
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State | FL
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Zip | 33076-3388
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Country | US
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Telephone | 954-752-6974
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Fax |
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Provider Business Mailing Address
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Address Line | 8789 W EASTMAN DR
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City | LAKEWOOD
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State | CO
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Zip | 80227-4721
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Country | US
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Telephone | 913-909-5586
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Fax |
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA0013427
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A-1341
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License Number State | NM
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