Provider Demographics
NPI:1477973949
Name:FREDMONSKY, JOHN ERIC
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ERIC
Last Name:FREDMONSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:ERIC
Other - Last Name:FREDMONSKY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:3403 VALLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-5303
Mailing Address - Country:US
Mailing Address - Phone:440-821-5193
Mailing Address - Fax:
Practice Address - Street 1:3403 VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-5303
Practice Address - Country:US
Practice Address - Phone:440-821-5193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-23
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH040852251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH04085OtherPHYSICAL THERAPIST