Provider Demographics
NPI:1700334463
Name:KING, JESSICA ANN (PT, DPT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:KING
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ANN
Other - Last Name:PRINTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2001 BUTTERFIELD RD STE 1600
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16139 LANCASTER HWY STE 140
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2976
Practice Address - Country:US
Practice Address - Phone:866-483-5378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCP030127T225100000X
COCP008785T225100000X
WACP003729T225100000X
VA2305213851225100000X
NCCP043325T225100000X
CA302239225100000X
PAPT032180225100000X
GACP027747T225100000X
MOCP030161T225100000X
TNCP027748T225100000X
TX1363029225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist