MEDICARE: JAIME DIADIUN KENT PT, DPT

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
1	2251P0200X	Pediatric Physical Therapist	1218974	TX

General Provider Information

NPI Number	:	1851631253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAIME DIADIUN KENT PT, DPT

Provider Business Mailing Address
First Line	:	33905 ROSEWOOD TRL
Second Line	:
City	:	WILLOUGHBY HILLS
State	:	OH
Zip	:	44094-8471
Country	:	US
Telephone Number	:	440-478-8707
Fax Number	:

Provider Business Practice Location Address
First Line	:	1821 LINCOLN RD
Second Line	:
City	:	WICKLIFFE
State	:	OH
Zip	:	44092-2416
Country	:	US
Telephone Number	:	440-943-0320
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2013
Last Update Date	:	07/21/2022

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