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NPI Code Detail

MEDICARE: JACLYN PERDZIAK

MEDICARE: JACLYN PERDZIAK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy AssistantPTA 4280OH

General Provider Information

NPI Number : 1780889550
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACLYN PERDZIAK
Provider Business Mailing Address
First Line : 172 COLONIAL DR
Second Line :
City : PAINESVILLE
State : OH
Zip : 44077-3683
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7201 WADE PARK AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44103-2765
Country : US
Telephone Number : 216-361-6141
Fax Number : 216-361-0766
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2007
Last Update Date : 07/08/2007

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Directions to “ JACLYN PERDZIAK ” Practice Location

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