Provider Demographics
NPI:1356626014
Name:STURGILL, JEFF WADE (LMT)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:WADE
Last Name:STURGILL
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7665 MONARCH CT STE 110
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-2484
Mailing Address - Country:US
Mailing Address - Phone:513-777-9428
Mailing Address - Fax:513-777-3628
Practice Address - Street 1:7665 MONARCH CT STE 110
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-2484
Practice Address - Country:US
Practice Address - Phone:513-777-9428
Practice Address - Fax:513-777-3628
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33-01-1678-5225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist