Provider Demographics
NPI:1982828653
Name:DECENA, JESUS ANTONIO
Entity Type:Individual
Prefix:MR
First Name:JESUS
Middle Name:ANTONIO
Last Name:DECENA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7315 QUAIL ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4202
Mailing Address - Country:US
Mailing Address - Phone:989-233-8288
Mailing Address - Fax:
Practice Address - Street 1:2626 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2422
Practice Address - Country:US
Practice Address - Phone:989-233-8288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5502000539OtherPHYSICAL THERAPIST ASSISTANT