Provider Demographics
NPI:1902468119
Name:MCLAUGHLIN, JESSICA MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:MCLAUGHLIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:989 BLUE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-8113
Mailing Address - Country:US
Mailing Address - Phone:607-423-1797
Mailing Address - Fax:
Practice Address - Street 1:947 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-2032
Practice Address - Country:US
Practice Address - Phone:508-720-0258
Practice Address - Fax:508-233-3055
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24319225100000X
NY043290225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist