Provider Demographics
NPI:1073565883
Name:SPORTS REHABILITATION CONSULTANTS, INC.
Entity Type:Organization
Organization Name:SPORTS REHABILITATION CONSULTANTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, ATC
Authorized Official - Phone:216-621-0022
Mailing Address - Street 1:3866 CARNEGIE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-2718
Mailing Address - Country:US
Mailing Address - Phone:216-621-0022
Mailing Address - Fax:216-621-5479
Practice Address - Street 1:3866 CARNEGIE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2718
Practice Address - Country:US
Practice Address - Phone:216-621-0022
Practice Address - Fax:216-621-5479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2101504Medicaid
OHSP9290681Medicare ID - Type UnspecifiedMEDICARE OH VNA GRP