Basic Information
| Provider Information | |||||||||
| NPI: | 1619070513 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MILLENNIUM REHABILITATION- A PHYSICAL THERAPY AND SPORTS MEDICINE CTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2567 CENTER RD | ||||||||
| Address2: | |||||||||
| City: | HINCKLEY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442339561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3305580100 | ||||||||
| FaxNumber: | 3305580110 | ||||||||
| Practice Location | |||||||||
| Address1: | 2546 CENTER RD | ||||||||
| Address2: | |||||||||
| City: | HINCKLEY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442339561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3305580100 | ||||||||
| FaxNumber: | 3305580110 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2006 | ||||||||
| LastUpdateDate: | 12/27/2019 | ||||||||
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| AuthorizedOfficialLastName: | STRAZAR | ||||||||
| AuthorizedOfficialFirstName: | PATRICIA | ||||||||
| AuthorizedOfficialMiddleName: | JEAN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER, CEO | ||||||||
| AuthorizedOfficialTelephone: | 3305580100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
| NPICertificationDate: | 12/27/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
ID Information
| ID | Type | State | Issuer | Description | 2567913 | 05 | OH | MEDICAID |