Jesseca Lynn Full, P.T.A.

Key facts

NPI

1154634889

Entity type

Individual (NPI type 1)

Primary specialty

Physical Therapy Assistant 225200000X

License

PTA 001094 (WV)

Practice address

200 Hospital Dr
Spencer, WV 25276-1050

Phone

(304) 927-4444

NPI assigned

Jul 22, 2010

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 22, 2010.

{
    "created_epoch": "1279756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279756800000",
    "number": "1154634889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "RR 2 BOX 24A",
            "city": "ELIZABETH",
            "state": "WV",
            "postal_code": "261439767",
            "telephone_number": "304-275-3889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HOSPITAL DR",
            "city": "SPENCER",
            "state": "WV",
            "postal_code": "252761050",
            "telephone_number": "304-927-4444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULL",
        "first_name": "JESSECA",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "P.T.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-22",
        "last_updated": "2010-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WV",
            "license": "PTA 001094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Spencer, WV · Physical Therapy Assistant in West Virginia