Healthcare Provider Details

I. General information

NPI: 1780417618
Provider Name (Legal Business Name): MICHELLE JICHA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5490 MILLS CREEK LN
NORTH RIDGEVILLE OH
44039-2339
US

IV. Provider business mailing address

5490 MILLS CREEK LN
NORTH RIDGEVILLE OH
44039-2339
US

V. Phone/Fax

Practice location:
  • Phone: 440-353-1100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number.13133
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: