Provider Demographics
NPI:1609227172
Name:SAKIE, JESSICA ANN (PT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:SAKIE
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 1:3118 HOLLY DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-3732
Mailing Address - Country:US
Mailing Address - Phone:614-668-0595
Mailing Address - Fax:
Practice Address - Street 1:7390 OLD OAK BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3328
Practice Address - Country:US
Practice Address - Phone:440-816-8010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH012057225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist