Provider Demographics
NPI:1477038990
Name:LONG, DENICE JASPHER (PT)
Entity Type:Individual
Prefix:
First Name:DENICE JASPHER
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PUTNAM ST STE 800
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-3013
Mailing Address - Country:US
Mailing Address - Phone:614-340-7587
Mailing Address - Fax:614-340-7588
Practice Address - Street 1:5003 PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-4326
Practice Address - Country:US
Practice Address - Phone:216-370-0016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT014381225100000X
TX1214949225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist