Provider Demographics
NPI:1588877807
Name:VITLAR, JESSICA ANNE (MPT)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:ANNE
Last Name:VITLAR
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 BROADWAY E
Mailing Address - Street 2:APT 211
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-4698
Mailing Address - Country:US
Mailing Address - Phone:206-949-0037
Mailing Address - Fax:
Practice Address - Street 1:747 BROADWAY
Practice Address - Street 2:6 WEST
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4379
Practice Address - Country:US
Practice Address - Phone:206-386-3578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009344225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist