Provider Demographics
NPI:1326366923
Name:LOZADA, JAY F (PT)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:F
Last Name:LOZADA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-395-8805
Mailing Address - Fax:740-395-8855
Practice Address - Street 1:280 PATTONSVILLE RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-9452
Practice Address - Country:US
Practice Address - Phone:740-395-8805
Practice Address - Fax:740-395-8855
Is Sole Proprietor?:No
Enumeration Date:2010-05-07
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.007802225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000301941OtherOHO MEDICAID UNISOURCE
0309027OtherCIGNA
WV10031001OtherBWC
000000658779OtherANTHEM
WV3810017531Medicaid
OHP00841139OtherRR MEDICARE
OH3041824OtherOH MEDICAID MOLINA
OH310917085167OtherOH MEDICAID CARESOURCE
OH3041827Medicaid
OH310917085167OtherOH MEDICAID CARESOURCE