Provider Demographics
NPI:1033930300
Name:SLOCUM, JESSE J (DPT)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:J
Last Name:SLOCUM
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 W PINE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-9319
Mailing Address - Country:US
Mailing Address - Phone:330-692-0923
Mailing Address - Fax:
Practice Address - Street 1:951 W PINE LAKE RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-9319
Practice Address - Country:US
Practice Address - Phone:330-692-0923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT020011225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist