Jessica J Tidswell, PT, DPT, SCS, ATC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5080663-2401 Issued in UT

Practice address

2760 Rasmussen Rd
Suite D2-D3
Park City, UT 84098-5684

Phone

(801) 718-5378

Fax

(801) 718-5378

NPI assigned

Aug 16, 2007

Last updated

Dec 27, 2021By 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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

• Peak Performance Physical Therapy, PC

  dba Peak Performance Sports Medicine

  • Physical Therapy Clinic/Center
  • Park City, UT
  • NPI 1073933966
  NPD (past) Authorized official
• Summit Sports Performance and Rehab Center, PLLC

  • Physical Therapy Clinic/Center
  • Park City, UT
  • NPI 1972915874
  NPD (past) Authorized official

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

{
    "created_epoch": "1187222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640563200000",
    "number": "1952593568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 ASPEN DR",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "840985134",
            "telephone_number": "801-718-5378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2760 RASMUSSEN RD",
            "address_2": "SUITE D2-D3",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "840985684",
            "telephone_number": "801-718-5378",
            "fax_number": "801-718-5378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDSWELL",
        "first_name": "JESSICA",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "PT, DPT, SCS, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-16",
        "last_updated": "2021-12-27",
        "certification_date": "2021-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "UT",
            "license": "5080663-2401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jtidswell3142@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Brianne Claire Thompson, MS, RD
• Colette Yolanda Thompson, COTA
• Nicole Lee Thorsen, CNM
• Marie T Thrasher, APRN
• Thrive Mental Health, LLC
• Jessica Tilson
• Timothy Duerler MD PLLC
• TMS Elevated
• Joseph Tooley Jr., PHARMD, MBA
• Christopher Hill Toone, ATC

• Physical Therapist in Park City, UT
• Providers in Park City, UT by specialty
• Physical Therapist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2021; 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.