Provider Demographics
NPI:1497539977
Name:LAKEWOOD FUNCTIONAL REHAB
Entity Type:Organization
Organization Name:LAKEWOOD FUNCTIONAL REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANTZIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:216-284-3077
Mailing Address - Street 1:PO BOX 64
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44286-0064
Mailing Address - Country:US
Mailing Address - Phone:216-284-3077
Mailing Address - Fax:
Practice Address - Street 1:11716 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3002
Practice Address - Country:US
Practice Address - Phone:216-284-3077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy