Basic Information
| Provider Information | |||||||||
| NPI: | 1467115030 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PT CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2660 W MARKET ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | FAIRLAWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443334209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308692635 | ||||||||
| FaxNumber: | 3308698315 | ||||||||
| Practice Location | |||||||||
| Address1: | 2660 W MARKET ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | FAIRLAWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443334209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308692635 | ||||||||
| FaxNumber: | 3308698315 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2021 | ||||||||
| LastUpdateDate: | 10/20/2021 | ||||||||
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| AuthorizedOfficialLastName: | OUTWATER | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/ PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 3308692635 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | SR. | ||||||||
| AuthorizedOfficialCredential: | PT, ATC | ||||||||
| NPICertificationDate: | 10/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.