Individual
DR. JESSE RUSSELL MODICA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T., D.P.T., M.S.
Contact information
Practice address
165 N REDWOOD DR, SUITE 120, SAN RAFAEL, CA 94903-1969
(415) 499-0278
Mailing address
165 N REDWOOD DR, SUITE 120, SAN RAFAEL, CA 94903-1969
(414) 499-0278
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
33875
CA
Other
Enumeration date
05/21/2008
Last updated
04/10/2020
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