Provider Demographics
NPI:1407121130
Name:STRONGSVILLE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:STRONGSVILLE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:KNAZEK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MPT
Authorized Official - Phone:440-783-8720
Mailing Address - Street 1:13477 PROSPECT RD # 104D
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44149-3867
Mailing Address - Country:US
Mailing Address - Phone:440-783-8720
Mailing Address - Fax:440-783-8721
Practice Address - Street 1:13477 PROSPECT RD # 104D
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44149-3867
Practice Address - Country:US
Practice Address - Phone:440-783-8720
Practice Address - Fax:440-783-8721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 011738225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty