Provider Demographics
NPI:1306109582
Name:MASH, JESSICA LEE (PTA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:MASH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3456 BEALE AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-1312
Mailing Address - Country:US
Mailing Address - Phone:814-932-5632
Mailing Address - Fax:
Practice Address - Street 1:3456 BEALE AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-1312
Practice Address - Country:US
Practice Address - Phone:814-932-5632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE1002166171000000X
225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No171000000XOther Service ProvidersMilitary Health Care Provider