Provider Demographics
NPI:1265907000
Name:PHIFER, JESSICA MARJORIE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARJORIE
Last Name:PHIFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4911 ROCKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-2854
Mailing Address - Country:US
Mailing Address - Phone:704-621-0693
Mailing Address - Fax:
Practice Address - Street 1:4911 ROCKWOOD RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-2854
Practice Address - Country:US
Practice Address - Phone:704-621-0693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-08
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist