Healthcare Provider Details

I. General information

NPI: 1437572047
Provider Name (Legal Business Name): JESSICA FIUTEM P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2014
Last Update Date: 02/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 MIRAMAR BLVD
UNIVERSITY HEIGHTS OH
44118-3301
US

IV. Provider business mailing address

2155 MIRAMAR BLVD
UNIVERSITY HEIGHTS OH
44118-3301
US

V. Phone/Fax

Practice location:
  • Phone: 216-320-5032
  • Fax:
Mailing address:
  • Phone: 216-320-5032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT.011223
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: