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General NPI Number Information
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NPI Number | 1982828653
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Entity Type | Individual
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Provider Name | MR. JESUS ANTONIO DECENA
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Gender | Male
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 09/27/2021
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Provider Practice Location Address
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Address Line | 2626 N MICHIGAN AVE
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City | SAGINAW
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State | MI
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Zip | 48604-2422
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Country | US
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Telephone | 989-233-8288
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Fax |
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Provider Business Mailing Address
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Address Line | 7315 QUAIL ST
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City | PORTAGE
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State | MI
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Zip | 49024-4202
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Country | US
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Telephone | 989-233-8288
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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