Provider Demographics
NPI:1497984132
Name:RAKYTA, SAMUEL JONATHAN II (DPT)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:JONATHAN
Last Name:RAKYTA
Suffix:II
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 W LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OH
Mailing Address - Zip Code:44425-1750
Mailing Address - Country:US
Mailing Address - Phone:330-534-8500
Mailing Address - Fax:330-534-3926
Practice Address - Street 1:609 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:HUBBARD
Practice Address - State:OH
Practice Address - Zip Code:44425-1750
Practice Address - Country:US
Practice Address - Phone:330-534-8500
Practice Address - Fax:330-534-3926
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 012451225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
341877311-00OtherBWC
OH341877311030OtherCARESOURCE
OH64-97047OtherUNITED HEALTHCARE