Provider Demographics
NPI:1871273250
Name:UMHOLTZ, JESSICA LEE (PTA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:UMHOLTZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LEE
Other - Last Name:BARSTOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:837 GLENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-7412
Mailing Address - Country:US
Mailing Address - Phone:814-931-6863
Mailing Address - Fax:
Practice Address - Street 1:1020 GREEN AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4623
Practice Address - Country:US
Practice Address - Phone:814-946-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI002696225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant