Provider Demographics
NPI:1063769024
Name:MAAG, JENNA MARIE (DPT)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:MAAG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:MARIE
Other - Last Name:ZEISLOFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:7595 COUNTY ROAD 236
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-8738
Mailing Address - Country:US
Mailing Address - Phone:419-427-1984
Mailing Address - Fax:419-427-2524
Practice Address - Street 1:PO BOX 565
Practice Address - Street 2:
Practice Address - City:KALIDA
Practice Address - State:OH
Practice Address - Zip Code:45853-0565
Practice Address - Country:US
Practice Address - Phone:419-427-1984
Practice Address - Fax:419-427-2524
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT013884225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0075387Medicaid
OHH123560Medicare PIN