1033250030 NPI number — MAYFIELD PHYSICAL THERAPY INC

Table of content: (NPI 1033250030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033250030 NPI number — MAYFIELD PHYSICAL THERAPY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAYFIELD PHYSICAL THERAPY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MAYFIELD PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033250030
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
781 BETA DR
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
MAYFIELD VILLAGE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44143-2356
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-442-7111
Provider Business Mailing Address Fax Number:
440-460-1767

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
781 BETA DR
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
MAYFIELD VILLAGE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-442-7111
Provider Business Practice Location Address Fax Number:
440-460-1767
Provider Enumeration Date:
02/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JENKINS
Authorized Official First Name:
BRADLEY
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
440-442-7111

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  08626 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP2000X , with the licence number: 1572 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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