Basic Information
Provider Information
NPI: 1811664170
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FINNEY
FirstName: JESSICA
MiddleName: LEIGH
NamePrefix: DR.
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3901 UNIVERSITY BLVD S
Address2:  
City: JACKSONVILLE
State: FL
PostalCode: 322164312
CountryCode: US
TelephoneNumber: 9043457251
FaxNumber:  
Practice Location
Address1: 11705 SAN JOSE BLVD STE 111
Address2:  
City: JACKSONVILLE
State: FL
PostalCode: 322231653
CountryCode: US
TelephoneNumber: 9043457450
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/25/2021
LastUpdateDate: 08/25/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/25/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT37242FLY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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