Provider Demographics
NPI:1972723559
Name:SIA, JASMINE T (PT)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:T
Last Name:SIA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10259 3RD ST NE UNIT A
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-5407
Mailing Address - Country:US
Mailing Address - Phone:630-201-1089
Mailing Address - Fax:
Practice Address - Street 1:2945 HAZELWOOD ST
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1241
Practice Address - Country:US
Practice Address - Phone:651-364-6356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014158225100000X
MN10699225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist