| NPI | 1740749167 |
|---|---|
| Former Name | JESSICA RAE STEPHENSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P24596) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NC LAT-4847) |
| Enumeration Date | 2019-03-15 |
| Last Update Date | 2026-01-02 |