Provider Demographics
NPI:1861787095
Name:PYATT, JESSICA (PT, DPT, WCS, CLT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PYATT
Suffix:
Gender:F
Credentials:PT, DPT, WCS, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 REMINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835-9752
Mailing Address - Country:US
Mailing Address - Phone:907-623-8097
Mailing Address - Fax:
Practice Address - Street 1:206 SEWARD ST STE B
Practice Address - Street 2:
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-7526
Practice Address - Country:US
Practice Address - Phone:907-738-3926
Practice Address - Fax:360-404-7441
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11234225100000X
WA60319755225100000X
OR60043225100000X
AK2595225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1584740Medicaid
WI1861787095Medicaid
AK1746672Medicaid