Provider Demographics
NPI:1316366966
Name:JAKOMIN, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:JAKOMIN
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 1:2730 MORNING STAR CT
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44094-9800
Mailing Address - Country:US
Mailing Address - Phone:440-944-6997
Mailing Address - Fax:
Practice Address - Street 1:29017 CHARDON RD
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY HILLS
Practice Address - State:OH
Practice Address - Zip Code:44092-1405
Practice Address - Country:US
Practice Address - Phone:440-516-5400
Practice Address - Fax:440-516-5197
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.002726225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist