Provider Demographics
NPI:1437384120
Name:HEADWAY PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:HEADWAY PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHILOH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:440-223-9765
Mailing Address - Street 1:9165 FAIRMOUNT RD
Mailing Address - Street 2:
Mailing Address - City:NOVELTY
Mailing Address - State:OH
Mailing Address - Zip Code:44072-9765
Mailing Address - Country:US
Mailing Address - Phone:440-223-9765
Mailing Address - Fax:
Practice Address - Street 1:9165 FAIRMOUNT RD
Practice Address - Street 2:
Practice Address - City:NOVELTY
Practice Address - State:OH
Practice Address - Zip Code:44072-9765
Practice Address - Country:US
Practice Address - Phone:440-223-9765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-25
Last Update Date:2009-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH009726261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy