Provider Demographics
NPI:1376621045
Name:MCDONALD, JENNIFER S (DPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:S
Other - Last Name:SIROTAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:6480 HARRISON AVENUE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247
Mailing Address - Country:US
Mailing Address - Phone:513-354-3700
Mailing Address - Fax:513-354-7651
Practice Address - Street 1:500 E- BUSINESS WAY
Practice Address - Street 2:SUITE C
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241
Practice Address - Country:US
Practice Address - Phone:513-389-3666
Practice Address - Fax:513-389-3665
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 10378225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0214940Medicaid
OH0214940Medicaid
OHSI4209512Medicare PIN