Healthcare Provider Details

I. General information

NPI: 1679880868
Provider Name (Legal Business Name): JACLYN R GARGANO DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACLYN R GARGANO DPT

II. Dates (important events)

Enumeration Date: 09/09/2010
Last Update Date: 09/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 BELMONT AVE
YOUNGSTOWN OH
44505-1846
US

IV. Provider business mailing address

3000 BELMONT AVE
YOUNGSTOWN OH
44505-1846
US

V. Phone/Fax

Practice location:
  • Phone: 330-759-2603
  • Fax:
Mailing address:
  • Phone: 330-759-2603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 012968
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: