Provider Demographics
NPI:1871130161
Name:HISSAM, JESSICA (DPT)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:HISSAM
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 1:4240 BALMORAL DR SW STE 100
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5633
Mailing Address - Country:US
Mailing Address - Phone:256-883-1970
Mailing Address - Fax:256-883-8061
Practice Address - Street 1:97 HUGHES RD STE P
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-3401
Practice Address - Country:US
Practice Address - Phone:256-774-2978
Practice Address - Fax:256-774-2979
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH9739225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist