Healthcare Provider Details

I. General information

NPI: 1750672986
Provider Name (Legal Business Name): JESSICA ENSOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 04/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 SPRINGDALE RD
CINCINNATI OH
45231-1805
US

IV. Provider business mailing address

466 TOWNSHIP ROAD 248 W
KITTS HILL OH
45645-9069
US

V. Phone/Fax

Practice location:
  • Phone: 740-442-1412
  • Fax:
Mailing address:
  • Phone: 740-442-1412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA.07821
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: