Provider Demographics
NPI:1851631253
Name:KENT, JAIME DIADIUN (PT, DPT)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:DIADIUN
Last Name:KENT
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 1:33905 ROSEWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44094-8471
Mailing Address - Country:US
Mailing Address - Phone:440-478-8707
Mailing Address - Fax:
Practice Address - Street 1:1821 LINCOLN RD
Practice Address - Street 2:
Practice Address - City:WICKLIFFE
Practice Address - State:OH
Practice Address - Zip Code:44092-2416
Practice Address - Country:US
Practice Address - Phone:440-943-0320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12189742251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics