Provider Demographics
NPI:1184052573
Name:RIDDLE, JESSICA FOWLER (DPT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:FOWLER
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:FOWLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 COVAN CV
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-5518
Mailing Address - Country:US
Mailing Address - Phone:828-298-8249
Mailing Address - Fax:888-511-1844
Practice Address - Street 1:59 OAKDALE RD
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-3017
Practice Address - Country:US
Practice Address - Phone:828-966-9036
Practice Address - Fax:828-966-4538
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-22
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208099225100000X
NC15532225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist