Provider Demographics
NPI:1275780165
Name:POMPIGNANO, JACQUELINE E (L/PTA)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:E
Last Name:POMPIGNANO
Suffix:
Gender:F
Credentials:L/PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10402 JOHNNYCAKE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44077-2024
Mailing Address - Country:US
Mailing Address - Phone:440-357-0190
Mailing Address - Fax:
Practice Address - Street 1:7235 WHIPPLE AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-7137
Practice Address - Country:US
Practice Address - Phone:330-498-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA.01695225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant