Provider Demographics
NPI:1033250030
Name:MAYFIELD PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:MAYFIELD PHYSICAL THERAPY INC
Other - Org Name:MAYFIELD PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:440-442-7111
Mailing Address - Street 1:781 BETA DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2356
Mailing Address - Country:US
Mailing Address - Phone:440-442-7111
Mailing Address - Fax:440-460-1767
Practice Address - Street 1:781 BETA DR
Practice Address - Street 2:SUITE C
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143
Practice Address - Country:US
Practice Address - Phone:440-442-7111
Practice Address - Fax:440-460-1767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-11
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH086262251X0800X
OH1572261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0480951Medicare PIN