Provider Demographics
NPI:1881699122
Name:JASONTEK, JULIE B (PT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:B
Last Name:JASONTEK
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 1:10663 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4403
Mailing Address - Country:US
Mailing Address - Phone:513-794-8465
Mailing Address - Fax:513-792-3230
Practice Address - Street 1:10663 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4403
Practice Address - Country:US
Practice Address - Phone:513-794-8465
Practice Address - Fax:513-792-3230
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT064542251X0800X
KYPT0028132251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY8700155800Medicaid
OH2526332Medicaid
OH2526332Medicaid
KY0239481Medicare PIN