Provider Demographics
NPI:1427514629
Name:TIERNEY, JESSICA ANNE (DPT)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ANNE
Last Name:TIERNEY
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 1:702 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-4536
Mailing Address - Country:US
Mailing Address - Phone:720-340-8339
Mailing Address - Fax:720-902-8099
Practice Address - Street 1:702 10TH AVE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-4536
Practice Address - Country:US
Practice Address - Phone:720-340-8339
Practice Address - Fax:720-902-8099
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60902832225100000X
COPTL.0016661225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist