Basic Information
| Provider Information | |||||||||
| NPI: | 1043354467 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZOCCHI | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | JO | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | P.T.A. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LAVIGNE | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | JO | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | P.T.A. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1331 BEECHVIEW DR | ||||||||
| Address2: | |||||||||
| City: | VERMILION | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440891605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4409670277 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4511 ROCKSIDE RD | ||||||||
| Address2: | SUITE 330 | ||||||||
| City: | INDEPENDENCE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441312199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8779070400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | PTA 03796 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.