Provider Demographics
NPI:1871800474
Name:PISANO, JESSICA S (DPT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:S
Last Name:PISANO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:23811 CHAGRIN BLVD
Mailing Address - Street 2:STE 120
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5555
Mailing Address - Country:US
Mailing Address - Phone:216-682-0413
Mailing Address - Fax:216-682-0417
Practice Address - Street 1:23811 CHAGRIN BLVD
Practice Address - Street 2:STE 120
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5555
Practice Address - Country:US
Practice Address - Phone:216-682-0413
Practice Address - Fax:216-682-0417
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH015329225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH13578147OtherCAQH