Provider Demographics
NPI:1780149815
Name:CISERO, JANAE V (PT)
Entity type:Individual
Prefix:
First Name:JANAE
Middle Name:V
Last Name:CISERO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3846 ANDERSON WOODS DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-9226
Mailing Address - Country:US
Mailing Address - Phone:904-710-2729
Mailing Address - Fax:
Practice Address - Street 1:3846 ANDERSON WOODS DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-9226
Practice Address - Country:US
Practice Address - Phone:904-710-2729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-03
Last Update Date:2020-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24268225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist