Individual
MISS JESSICA M WESTENHAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1613 EDGAR AVE, MATTOON, IL 61938-5249
(217) 294-1706
Mailing address
1613 EDGAR AVE, MATTOON, IL 61938-5249
(217) 294-1706
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
06003771A
IN
225700000X
Massage Therapist
Primary
227007327
IL
Other
Enumeration date
12/28/2008
Last updated
12/28/2008
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