Provider Demographics
NPI:1790092310
Name:JUMP START THERAPY, PT, OT, SLP, PLLC
Entity Type:Organization
Organization Name:JUMP START THERAPY, PT, OT, SLP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:917-570-7008
Mailing Address - Street 1:2 BERWICK CIR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10930-8309
Mailing Address - Country:US
Mailing Address - Phone:917-570-7008
Mailing Address - Fax:845-827-5496
Practice Address - Street 1:2 BERWICK CIR
Practice Address - Street 2:
Practice Address - City:HIGHLAND MILLS
Practice Address - State:NY
Practice Address - Zip Code:10930-8309
Practice Address - Country:US
Practice Address - Phone:917-570-7008
Practice Address - Fax:845-827-5496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016291-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency