Individual
JESSICA MARIE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
548 RUNNING W DR, GILLETTE, WY 82718-2074
(307) 670-9444
(307) 670-9188
Mailing address
548 RUNNING W DR, GILLETTE, WY 82718-2074
(307) 670-9444
(307) 670-9188
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-1126
WY
Other
Enumeration date
01/22/2024
Last updated
01/22/2024
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