Provider Demographics
NPI:1619792025
Name:GALVIN, JESSICA E (DPT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:E
Last Name:GALVIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 YORK RD
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1930
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:3206 PEACH ORCHARD RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-3540
Practice Address - Country:US
Practice Address - Phone:706-772-9323
Practice Address - Fax:706-772-8873
Is Sole Proprietor?:No
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT017490225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist