Jessica Catherine Tubergen, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

5502003228 Issued in MI

Practice address

3491 Lincoln Rd
Hamilton, MI 49419-9512

Phone

(269) 751-2150

NPI assigned

Aug 7, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Jessica Dekker Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• West Michigan Rehabilitation PC

  • Rehabilitation Clinic/Center
  • Hamilton, MI
  • NPI 1780614909
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1312675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337731200000",
    "number": "1013296144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44 E 8TH ST",
            "address_2": "SUITE 205",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494233575",
            "telephone_number": "616-392-3197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3491 LINCOLN RD",
            "city": "HAMILTON",
            "state": "MI",
            "postal_code": "494199512",
            "telephone_number": "269-751-2150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUBERGEN",
        "first_name": "JESSICA",
        "middle_name": "CATHERINE",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-07",
        "last_updated": "2012-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MI",
            "license": "5502003228",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "DEKKER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kelli Ann Smith, PHARMD
• Frances Reed Talsma, LMSW
• Heather Jean Tenelshof, PTA
• Alicia Tock
• Tara E Tomman, D.C.
• Visualeyes Center of Visual Development, PLLC
• West Michigan Rehabilitation PC
• Benjamin H Wickstra, DDS
• Donald Jay Wickstra, DDS
• Wuis Value Drugs, Inc

• All providers in Hamilton, MI
• Physical Therapy Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.