Provider Demographics
NPI:1245371301
Name:KACSANDI, JEFFREY L (PT)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:L
Last Name:KACSANDI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1853 MOORE RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-1786
Mailing Address - Country:US
Mailing Address - Phone:440-653-6031
Mailing Address - Fax:
Practice Address - Street 1:4511 ROCKSIDE RD
Practice Address - Street 2:SUITE 330
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2199
Practice Address - Country:US
Practice Address - Phone:216-901-0400
Practice Address - Fax:216-901-0401
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT. 009396225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist