Provider Demographics
NPI:1548267495
Name:SCHAEFER, JESSICA LEIGH (PT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEIGH
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5712 XERXES AVE S
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55410-2639
Mailing Address - Country:US
Mailing Address - Phone:952-926-6205
Mailing Address - Fax:
Practice Address - Street 1:7250 FRANCE AVE S
Practice Address - Street 2:SUITE 111
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4305
Practice Address - Country:US
Practice Address - Phone:952-873-8991
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7187225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist