Provider Demographics
NPI:1477978864
Name:HARDY, JESSICA LYNN (DPT)
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:LYNN
Last Name:HARDY
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 1:307 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1543
Mailing Address - Country:US
Mailing Address - Phone:207-754-5138
Mailing Address - Fax:
Practice Address - Street 1:394 BAR HARBOR RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:ME
Practice Address - Zip Code:04605
Practice Address - Country:US
Practice Address - Phone:207-667-5899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-22
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT4099225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist