1245510916 NPI number — JESSICA SCHNELL PHYSICAL THERAPY, LLC

Table of content: (NPI 1245510916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245510916 NPI number — JESSICA SCHNELL PHYSICAL THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JESSICA SCHNELL PHYSICAL THERAPY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245510916
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5000 ESTATE ENIGHED
Provider Second Line Business Mailing Address:
PMB 535
Provider Business Mailing Address City Name:
ST JOHN
Provider Business Mailing Address State Name:
VI
Provider Business Mailing Address Postal Code:
00830-6120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
340-642-5602
Provider Business Mailing Address Fax Number:
800-403-8365

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 ENIGHED, SUITE #104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT JOHN
Provider Business Practice Location Address State Name:
VI
Provider Business Practice Location Address Postal Code:
00830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
340-514-2376
Provider Business Practice Location Address Fax Number:
800-403-8365
Provider Enumeration Date:
08/25/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SCHNELL
Authorized Official First Name:
JESSICA
Authorized Official Middle Name:
MICHELLE
Authorized Official Title or Position:
PHYSICAL THERAPIST/SOLE PROPRIETOR
Authorized Official Telephone Number:
340-514-2376

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  153 , registered in the state of VI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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