Provider Demographics
NPI:1679880868
Name:GARGANO, JACLYN R (DPT)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:R
Last Name:GARGANO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:R
Other - Last Name:GARGANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:3000 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1846
Mailing Address - Country:US
Mailing Address - Phone:330-759-2603
Mailing Address - Fax:
Practice Address - Street 1:3000 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-1846
Practice Address - Country:US
Practice Address - Phone:330-759-2603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 012968225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist