Provider Demographics
NPI:1861723538
Name:OSGOOD, JESSICA I (PTA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:I
Last Name:OSGOOD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 SPRINGVIEW LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8153
Mailing Address - Country:US
Mailing Address - Phone:843-875-2959
Mailing Address - Fax:843-875-2836
Practice Address - Street 1:90 SPRINGVIEW LN
Practice Address - Street 2:SUITE B
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8153
Practice Address - Country:US
Practice Address - Phone:843-875-2959
Practice Address - Fax:843-875-2836
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2362225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant