Provider Demographics
NPI:1871972091
Name:JANSSE, TESS
Entity type:Individual
Prefix:
First Name:TESS
Middle Name:
Last Name:JANSSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1335
Mailing Address - Street 2:
Mailing Address - City:GENOA
Mailing Address - State:NV
Mailing Address - Zip Code:89411-1335
Mailing Address - Country:US
Mailing Address - Phone:775-790-3012
Mailing Address - Fax:
Practice Address - Street 1:2314 MAIN ST
Practice Address - Street 2:
Practice Address - City:GENOA
Practice Address - State:NV
Practice Address - Zip Code:89411-1542
Practice Address - Country:US
Practice Address - Phone:177-579-0301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2697225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist