Provider Demographics
NPI:1508983271
Name:CIACICO, MARY JANE M (PT, OCS)
Entity Type:Individual
Prefix:
First Name:MARY JANE
Middle Name:M
Last Name:CIACICO
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Gender:F
Credentials:PT, OCS
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Mailing Address - Street 1:720 COOL SPRINGS BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2626
Mailing Address - Country:US
Mailing Address - Phone:615-778-4066
Mailing Address - Fax:615-778-9114
Practice Address - Street 1:14061 E 13 MILE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-5866
Practice Address - Country:US
Practice Address - Phone:586-294-7077
Practice Address - Fax:586-294-7144
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2008-05-01
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Provider Licenses
StateLicense IDTaxonomies
MI5501006380225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist