Provider Demographics
NPI:1972146934
Name:FRANZ, JACLYN
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:FRANZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 SPRINGLAND CIR
Mailing Address - Street 2:
Mailing Address - City:SUGARCRK TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45305-9748
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:688 6TH STREET
Practice Address - Street 2:
Practice Address - City:FORT RICHARDSON
Practice Address - State:AK
Practice Address - Zip Code:99505
Practice Address - Country:US
Practice Address - Phone:907-384-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2022-10-31
Deactivation Date:2021-08-20
Deactivation Code:
Reactivation Date:2021-09-02
Provider Licenses
StateLicense IDTaxonomies
390200000X
MEPT6042225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program