MEDICARE: ANDREW JAKUSZEIT 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	225100000X	Physical Therapist	PT021497	OH

General Provider Information

NPI Number	:	1912717950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW JAKUSZEIT DPT

Provider Business Mailing Address
First Line	:	23936 HEDGEWOOD AVE
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-4305
Country	:	US
Telephone Number	:	216-609-2988
Fax Number	:

Provider Business Practice Location Address
First Line	:	3365 RICHMOND RD STE 110
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-4171
Country	:	US
Telephone Number	:	216-593-7070
Fax Number	:

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

Provider Enumeration Date	:	01/11/2025
Last Update Date	:	01/16/2025

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