Provider Demographics
NPI:1215349261
Name:WATERS, JESSICA (PT, DPT, OCS)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WATERS
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 TRANSPORTATION BLVD
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-5371
Mailing Address - Country:US
Mailing Address - Phone:216-518-3626
Mailing Address - Fax:
Practice Address - Street 1:5555 TRANSPORTATION BLVD
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-5371
Practice Address - Country:US
Practice Address - Phone:216-518-3626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-020727225100000X
NCP14877225100000X
OH0152512251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist