Provider Demographics
NPI:1558515866
Name:STABILITY PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:STABILITY PHYSICAL THERAPY, LLC
Other - Org Name:STABILITY REHABILITATION GROUP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:440-290-4437
Mailing Address - Street 1:PO BOX 5024
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44061-5024
Mailing Address - Country:US
Mailing Address - Phone:440-290-4437
Mailing Address - Fax:440-290-4438
Practice Address - Street 1:600 STATE RD
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-3933
Practice Address - Country:US
Practice Address - Phone:440-992-3594
Practice Address - Fax:440-290-4438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-13
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT9226261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy