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 1:356 MAIN DUNSTABLE RD
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-1820
Mailing Address - Country:US
Mailing Address - Phone:603-703-6429
Mailing Address - Fax:
Practice Address - Street 1:1595 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-2696
Practice Address - Country:US
Practice Address - Phone:978-735-4479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT5764225100000X
NH4717225100000X
MA25987225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist