1427162197 NPI number — MRS. REBECCA LYNN JESSOP MSPT

Table of content: MRS. REBECCA LYNN JESSOP MSPT (NPI 1427162197)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427162197 NPI number — MRS. REBECCA LYNN JESSOP MSPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JESSOP
Provider First Name:
REBECCA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1427162197
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 92
Provider Second Line Business Mailing Address:
4312 ROUTE 414
Provider Business Mailing Address City Name:
FAYETTE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-549-8787
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2109 ROUTES 5 AND 20
Provider Second Line Business Practice Location Address:
ORTHOPEDICS PLUS
Provider Business Practice Location Address City Name:
SENECA FALLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-568-2249
Provider Business Practice Location Address Fax Number:
315-568-1857
Provider Enumeration Date:
08/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  0215931 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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