Provider Demographics
NPI:1316475015
Name:MAIBACH, JESSICA (PT, DPT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MAIBACH
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 1:7420 EASTON RD
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:OH
Mailing Address - Zip Code:44276-9768
Mailing Address - Country:US
Mailing Address - Phone:419-786-0915
Mailing Address - Fax:
Practice Address - Street 1:10680 STEINER RD
Practice Address - Street 2:
Practice Address - City:RITTMAN
Practice Address - State:OH
Practice Address - Zip Code:44270-9518
Practice Address - Country:US
Practice Address - Phone:330-927-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT016919225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist