Jessica Andersen, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

39611 Issued in CA

Practice address

404 Camino del Rio S Ste 508
San Diego, CA 92108-3503

Phone

(619) 325-0154

Fax

(619) 325-0172

NPI assigned

Mar 5, 2013

Last updated

Feb 2, 2024By the provider in NPPES

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 Rita Roldan Former name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Medicare enrollment (NPD)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Empower Mobile Physical Therapy Corporation

  • Physical Therapist
  • Vista, CA
  • NPI 1982292298
  Medicare reassignment NPD

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

{
    "created_epoch": "1362441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706832000000",
    "number": "1558602292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30230 DISNEY LN",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920841232",
            "telephone_number": "760-630-8658",
            "fax_number": "760-630-8658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 CAMINO DEL RIO S STE 508",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921083503",
            "telephone_number": "619-325-0154",
            "fax_number": "619-325-0172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSEN",
        "first_name": "JESSICA",
        "name_prefix": "Ms.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-05",
        "last_updated": "2024-02-02",
        "certification_date": "2024-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "39611",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "ROLDAN",
            "middle_name": "RITA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Miriam Andaya
• Megan Maria Anders, BCBA
• Emily Andersen
• Emma Linn Andersen
• Jared Andersen, L.AC
• Jillian Andersen
• Josefina Legaspi Andersen, RN
• Karie F Andersen, MD
• Kathryn Andersen
• Krystal Andersen

• Physical Therapist in San Diego, CA
• Providers in San Diego, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.