| NPI | 1801135611 |
|---|---|
| Former Name | JESSICA LESAGE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 27272) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 20416) |
| 225100000X Physical Therapist (Licence: DE J1-0003780) | |
| Enumeration Date | 2013-02-14 |
| Last Update Date | 2018-11-28 |