Provider Demographics
NPI:1073010260
Name:HASSEL, JILLIAN RYAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:RYAN
Last Name:HASSEL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2489 OVERLOOK RD APT 410
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-5605
Mailing Address - Country:US
Mailing Address - Phone:513-328-9391
Mailing Address - Fax:
Practice Address - Street 1:17322 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-1210
Practice Address - Country:US
Practice Address - Phone:216-486-2280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT017295225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist