Individual
JEFFERY LEE CIOCCA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
621 W NORTH ST, KENDALLVILLE, IN 46755-1009
(260) 343-0343
(260) 343-0533
Mailing address
PO BOX 350034, TOLEDO, OH 43635-0034
(260) 343-0343
(260) 343-0533
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05003606A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200154530
—
IN
05
—
200250170A
—
IN
Enumeration date
08/05/2006
Last updated
09/21/2011
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