Provider Demographics
NPI:1639459662
Name:JEZ, MARCIN (DPT)
Entity Type:Individual
Prefix:
First Name:MARCIN
Middle Name:
Last Name:JEZ
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 ALEXANDRIA PIKE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HEIGHTS
Mailing Address - State:KY
Mailing Address - Zip Code:41076-1590
Mailing Address - Country:US
Mailing Address - Phone:859-572-0710
Mailing Address - Fax:859-572-0716
Practice Address - Street 1:2600 ALEXANDRIA PIKE
Practice Address - Street 2:
Practice Address - City:HIGHLAND HEIGHTS
Practice Address - State:KY
Practice Address - Zip Code:41076-1590
Practice Address - Country:US
Practice Address - Phone:859-572-0710
Practice Address - Fax:859-572-0716
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005861225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK015820Medicare PIN