MEDICARE: JESSICA LANCASTER PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	6875	TN

General Provider Information

NPI Number	:	1255215240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LANCASTER PTA

Provider Business Mailing Address
First Line	:	505 ELLINGTON DR STE A
Second Line	:
City	:	LAFAYETTE
State	:	TN
Zip	:	37083-1074
Country	:	US
Telephone Number	:	615-666-5895
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 ELLINGTON DR STE A
Second Line	:
City	:	LAFAYETTE
State	:	TN
Zip	:	37083-1074
Country	:	US
Telephone Number	:	615-666-5895
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2025
Last Update Date	:	08/02/2025

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Directions to “ JESSICA LANCASTER PTA” Practice Location

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