Individual
JENESSA LIANNE BABCOCK
Active
Individual
JENESSA LIANNE BABCOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
05640
OR
225100000X
Physical Therapist
Primary
2424
MT
225100000X
Physical Therapist
2510
ID
225100000X
Physical Therapist
PTP-PT-LIC-2474
MT
Other
Enumeration date
01/25/2012
Last updated
12/12/2019
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