Provider Demographics
NPI:1447701669
Name:REISS, JASMINE (DPT)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:REISS
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 1:1880 RADFORD RD STE 4
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-2272
Mailing Address - Country:US
Mailing Address - Phone:563-583-3408
Mailing Address - Fax:563-265-5789
Practice Address - Street 1:1880 RADFORD RD STE 4
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-2272
Practice Address - Country:US
Practice Address - Phone:563-583-3408
Practice Address - Fax:563-265-5789
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA081437225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0665950Medicaid
IA166595Medicare PIN