Provider Demographics
NPI:1053442723
Name:SALHIEH, JESUSA
Entity type:Individual
Prefix:
First Name:JESUSA
Middle Name:
Last Name:SALHIEH
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 1:2516 LORENTSON CT
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-7089
Mailing Address - Country:US
Mailing Address - Phone:808-646-0508
Mailing Address - Fax:
Practice Address - Street 1:GENESIS REHAB BLOOM
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901
Practice Address - Country:US
Practice Address - Phone:317-627-0723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008438A171W00000X, 225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171W00000XOther Service ProvidersContractor