Provider Demographics
NPI:1124540158
Name:KLEIN, JESSIE NOEL (PT, DPT)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:NOEL
Last Name:KLEIN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:NOEL
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1240 N ITHICA ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-1732
Mailing Address - Country:US
Mailing Address - Phone:480-200-9234
Mailing Address - Fax:
Practice Address - Street 1:1930 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282
Practice Address - Country:US
Practice Address - Phone:480-456-0719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist