Provider Demographics
NPI:1144461138
Name:DORSEY, JESSICA ANNE (LMT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:DORSEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3775 SOUTHWESTERN BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2159
Mailing Address - Country:US
Mailing Address - Phone:716-649-1500
Mailing Address - Fax:716-667-1663
Practice Address - Street 1:3775 SOUTHWESTERN BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-2159
Practice Address - Country:US
Practice Address - Phone:716-649-1500
Practice Address - Fax:716-667-1663
Is Sole Proprietor?:No
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022881225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist