Provider Demographics
NPI:1467115030
Name:PT CENTER LLC
Entity Type:Organization
Organization Name:PT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:OUTWATER
Authorized Official - Suffix:SR
Authorized Official - Credentials:PT, ATC
Authorized Official - Phone:330-869-2635
Mailing Address - Street 1:2660 W MARKET ST STE 300
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4209
Mailing Address - Country:US
Mailing Address - Phone:330-869-2635
Mailing Address - Fax:330-869-8315
Practice Address - Street 1:2660 W MARKET ST STE 300
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-4209
Practice Address - Country:US
Practice Address - Phone:330-869-2635
Practice Address - Fax:330-869-8315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty