Provider Demographics
NPI:1104902113
Name:BOWER, JESSICA E (DPT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:E
Last Name:BOWER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3942 DAVIS STUART RD STE 3
Mailing Address - Street 2:
Mailing Address - City:RONCEVERTE
Mailing Address - State:WV
Mailing Address - Zip Code:24970-0269
Mailing Address - Country:US
Mailing Address - Phone:304-647-3987
Mailing Address - Fax:304-647-3990
Practice Address - Street 1:3942 DAVIS STUART RD STE 3
Practice Address - Street 2:
Practice Address - City:RONCEVERTE
Practice Address - State:WV
Practice Address - Zip Code:24970-0269
Practice Address - Country:US
Practice Address - Phone:304-647-3987
Practice Address - Fax:304-647-3990
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2537174400000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810004657Medicaid
WV550755833OtherWV WORKERS COMP
WV550755833OtherCOMMERICAL INS