Provider Demographics
NPI:1992310098
Name:WILD, JESSICA LYNNE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LYNNE
Last Name:WILD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYNNE
Other - Last Name:DIGGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:436 AMHERST ST STE 102
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-1276
Mailing Address - Country:US
Mailing Address - Phone:603-417-5087
Mailing Address - Fax:603-417-5089
Practice Address - Street 1:436 AMHERST ST STE 102
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-1276
Practice Address - Country:US
Practice Address - Phone:603-417-5087
Practice Address - Fax:603-417-5089
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4717225100000X
MEPT5764225100000X
MA25987225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist