Provider Demographics
NPI:1093820649
Name:PEDICINI, JASON ALAN (DPT)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ALAN
Last Name:PEDICINI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5791 ZARLEY ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-7090
Mailing Address - Country:US
Mailing Address - Phone:614-519-6045
Mailing Address - Fax:614-775-6105
Practice Address - Street 1:5791 ZARLEY ST
Practice Address - Street 2:SUITE B
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-7090
Practice Address - Country:US
Practice Address - Phone:614-519-6045
Practice Address - Fax:614-775-6105
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHPT10550225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist