Provider Demographics
NPI:1407645765
Name:WEYANT, JESSALYN
Entity type:Individual
Prefix:
First Name:JESSALYN
Middle Name:
Last Name:WEYANT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 POPLAR RUN RD
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635-3803
Mailing Address - Country:US
Mailing Address - Phone:814-515-7316
Mailing Address - Fax:
Practice Address - Street 1:310 UNION AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-3207
Practice Address - Country:US
Practice Address - Phone:814-317-6959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-03
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG015212225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist