Provider Demographics
NPI:1326183971
Name:PORTAGE PHYSICAL THERAPISTS ,INC
Entity Type:Organization
Organization Name:PORTAGE PHYSICAL THERAPISTS ,INC
Other - Org Name:ALLIED HEALTH REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRERA-MATHYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-297-9020
Mailing Address - Street 1:133 5TH ST SE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-9004
Mailing Address - Country:US
Mailing Address - Phone:330-297-9020
Mailing Address - Fax:
Practice Address - Street 1:771 N FREEDOM ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-2470
Practice Address - Country:US
Practice Address - Phone:330-297-9020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH224Z00000X, 225100000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0916610Medicaid
OH366710Medicare ID - Type UnspecifiedFACILITY LOCATION