Provider Demographics
NPI:1386835890
Name:PRO-ACTIVITIES LLC
Entity Type:Organization
Organization Name:PRO-ACTIVITIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:RAMONA
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:440-729-0405
Mailing Address - Street 1:8254 MAYFIELD RD STE 7
Mailing Address - Street 2:
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-2562
Mailing Address - Country:US
Mailing Address - Phone:440-729-0405
Mailing Address - Fax:440-729-0423
Practice Address - Street 1:8254 MAYFIELD RD STE 7
Practice Address - Street 2:
Practice Address - City:CHESTERLAND
Practice Address - State:OH
Practice Address - Zip Code:44026
Practice Address - Country:US
Practice Address - Phone:440-729-0405
Practice Address - Fax:440-729-0423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9372691Medicare PIN