Provider Demographics
NPI:1750603536
Name:COLFLESH, JESSICA A (DPT)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:A
Last Name:COLFLESH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:KENDZIORSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:110 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINTERSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43953-3734
Mailing Address - Country:US
Mailing Address - Phone:740-266-6855
Mailing Address - Fax:740-264-4376
Practice Address - Street 1:115 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINTERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43953-3733
Practice Address - Country:US
Practice Address - Phone:740-266-6855
Practice Address - Fax:740-264-4376
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT012306225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPT012306OtherLICENSE