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NPI Code Detail

MEDICARE: MS. JESSICA JEANIE TYSON

MEDICARE: MS. JESSICA JEANIE TYSON
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
1225100000XPhysical Therapist

General Provider Information

NPI Number : 1659647139
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JESSICA JEANIE TYSON
Provider Business Mailing Address
First Line : 17 MASER AVE
Second Line :
City : WHEELING
State : WV
Zip : 26003-7246
Country : US
Telephone Number : 304-312-5120
Fax Number :
Provider Business Practice Location Address
First Line : 316 WASHINGTON AVE
Second Line :
City : WHEELING
State : WV
Zip : 26003-6243
Country : US
Telephone Number : 304-243-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2012
Last Update Date : 03/28/2012

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Directions to “ MS. JESSICA JEANIE TYSON ” Practice Location

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