Provider Demographics
NPI:1427829597
Name:JESSICA M FUTCH PT DPT LLC
Entity type:Organization
Organization Name:JESSICA M FUTCH PT DPT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FUTCH
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:912-433-1269
Mailing Address - Street 1:1110 PATTERSON DR
Mailing Address - Street 2:
Mailing Address - City:GUYTON
Mailing Address - State:GA
Mailing Address - Zip Code:31312-5142
Mailing Address - Country:US
Mailing Address - Phone:912-433-1269
Mailing Address - Fax:
Practice Address - Street 1:812 TOWNE PARK DR STE 400
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-9364
Practice Address - Country:US
Practice Address - Phone:912-678-5132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center