Provider Demographics
NPI:1932440906
Name:SIU, JESSICA (PT,DPT)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:SIU
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5812 HALL CT
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-9272
Mailing Address - Country:US
Mailing Address - Phone:513-259-6996
Mailing Address - Fax:
Practice Address - Street 1:5812 HALL CT
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-9272
Practice Address - Country:US
Practice Address - Phone:513-259-6996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13036225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist