Provider Demographics
NPI:1730359191
Name:ANDRE, JESSIKA (PTA)
Entity type:Individual
Prefix:MS
First Name:JESSIKA
Middle Name:
Last Name:ANDRE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:JESSIKA
Other - Middle Name:
Other - Last Name:ANDRE-SYLVAIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:11102 ARBOR GREEN DR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-7740
Mailing Address - Country:US
Mailing Address - Phone:804-295-9399
Mailing Address - Fax:
Practice Address - Street 1:11102 ARBOR GREEN DR
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831
Practice Address - Country:US
Practice Address - Phone:804-295-9399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-01
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0061031225200000X
225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant