Provider Demographics
NPI:1679964282
Name:FOHRMAN, JESSICA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:FOHRMAN
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 1:279 5TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55929-1414
Mailing Address - Country:US
Mailing Address - Phone:507-202-6476
Mailing Address - Fax:
Practice Address - Street 1:279 5TH AVE SE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:MN
Practice Address - Zip Code:55929-1414
Practice Address - Country:US
Practice Address - Phone:507-202-6476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-18
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA369225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant