Individual
MR. BRENT HAMILTON JIVIDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
4100 W. THIRD STREET, DAYTON, OH 45428-9000
(937) 268-6511
Mailing address
4100 W. THIRD STREET, DAYTON, OH 45428
(937) 268-6511
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-006273
OH
Other
Enumeration date
10/02/2006
Last updated
07/08/2007
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