Provider Demographics
NPI:1992567622
Name:SADDI, JERMAINE
Entity type:Individual
Prefix:
First Name:JERMAINE
Middle Name:
Last Name:SADDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N SWITZER CANYON DR APT 145
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-4842
Mailing Address - Country:US
Mailing Address - Phone:929-988-3007
Mailing Address - Fax:
Practice Address - Street 1:900 N SWITZER CANYON DR APT 145
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4842
Practice Address - Country:US
Practice Address - Phone:929-988-3007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-033677225100000X
NY042896225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist