Healthcare Provider Details

I. General information

NPI: 1639904071
Provider Name (Legal Business Name): BJSG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14077 CEDAR RD STE LL1
SOUTH EUCLID OH
44118-3332
US

IV. Provider business mailing address

2905 E OVERLOOK RD
CLEVELAND HEIGHTS OH
44118-2433
US

V. Phone/Fax

Practice location:
  • Phone: 216-200-6959
  • Fax:
Mailing address:
  • Phone: 216-235-1047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESSICA JENKINS
Title or Position: OWNER
Credential: DPT
Phone: 216-200-6959