Provider Demographics
NPI:1851396634
Name:LEMCKE, JAY O (PT, ATC, OCS)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:O
Last Name:LEMCKE
Suffix:
Gender:M
Credentials:PT, ATC, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 N MEADOWS DR
Mailing Address - Street 2:SUITE 10
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8367
Mailing Address - Country:US
Mailing Address - Phone:724-272-2420
Mailing Address - Fax:724-934-6814
Practice Address - Street 1:10 N MEADOWS DR
Practice Address - Street 2:SUITE 10
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8367
Practice Address - Country:US
Practice Address - Phone:724-272-2420
Practice Address - Fax:724-934-6814
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001598385Medicaid
PAR06345Medicare UPIN
PA623372RK3Medicare PIN