Healthcare Provider Details

I. General information

NPI: 1609720432
Provider Name (Legal Business Name): JAKOB RAYMOND PICKETT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4333 MONROE ST STE D
TOLEDO OH
43606-1937
US

IV. Provider business mailing address

4333 MONROE ST STE D
TOLEDO OH
43606-1937
US

V. Phone/Fax

Practice location:
  • Phone: 419-472-2610
  • Fax: 419-472-2611
Mailing address:
  • Phone: 419-472-2610
  • Fax: 419-472-2611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: