Jessica Lynn Petty, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2016037457 Issued in MO

Practice address

12826 Daylight Cir
Saint Louis, MO 63131-1890

Phone

(314) 328-0441

NPI assigned

Jun 7, 2019

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1559865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559865600000",
    "number": "1063071561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1450 HARNESS RD",
            "city": "FESTUS",
            "state": "MO",
            "postal_code": "630285402",
            "telephone_number": "636-524-2322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12826 DAYLIGHT CIR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631311890",
            "telephone_number": "314-328-0441"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12826 Daylight Cir",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631311890",
            "country_code": "US",
            "telephone_number": "314-328-0441",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETTY",
        "first_name": "JESSICA",
        "middle_name": "LYNN",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-07",
        "last_updated": "2019-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MO",
            "license": "2016037457",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Pettis, MD
• Phyne Kierra Ann Pettis
• Kellen Seth Pettus, MD
• Alberta Petty
• Debbie Petty
• Jordan Petty
• Marcella M Petzchen, NP
• Nancy Pevnick, PTA
• Becky Ann Pew, M.D.
• Dorinda Peyton, LPC

• Physical Therapy Assistant in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Physical Therapy Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2019; 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.