Provider Demographics
NPI:1316357445
Name:ALT, JEROMY
Entity Type:Individual
Prefix:
First Name:JEROMY
Middle Name:
Last Name:ALT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 FRENCH HL E
Mailing Address - Street 2:3202 EDEN AVENUE
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45267-0394
Mailing Address - Country:US
Mailing Address - Phone:513-558-3725
Mailing Address - Fax:
Practice Address - Street 1:271 FRENCH HL E
Practice Address - Street 2:3202 EDEN AVENUE
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45267-0394
Practice Address - Country:US
Practice Address - Phone:513-558-3725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT 0027192255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer